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Contents
Acknowledgements ·----····· ···--···--··· ···-·... ·-··· ···-···.... . ... ..... ·-·. ·-···-···.... ... ...... .... . . . .... .. . " ... .iv
Chapter I-Philosophy, Science and Occupational Therapy I

Classical and Nonlinear Science: A Comparison of Views ...... .. . ·-·.. . .... ..... ··-· ...... ·-·-· ···-·. ··-·........ 3
Habits: Dynamic Boundaries in the Evolution of the Self . . ... ..... .... .................. .. ·-··· ·-·. ..... 11
The Stress Response and Homeodynamics .. . ···-... ... ......... ..... ....... .. ·-··--·-··········-· ···-··· ········-···................ . 14
Embodied Experiences: Here and Now . ...... . ............. ......... .. ... . ·-··--.... ...... ...... ····-· ····-· ... . .... . .... .21
Chapter II-Evaluation and Dynamic Systems . _ .. ······ ·-····23

Exploring Dynamic System Tendencies . . ...... . .... ...... . .. .... .. ..... ......... .. ..... -· . --- ..... .... ...... 25
Cognitive Evaluation .. . .... .. ... . .... . ... . ..... .... . ·-· ····-···-· · ·-28
The CDE Model and Allen Cognitive Levels . ... _ --· ······-··· ···-···31
Embodied Cognition Reconsidered ... ·---·--· ....38
Sensory Processing and Occupation ..... ... . - . - ...... . ·-· ·--·. 39
Sensory Modulation and Degrees of Severity . ······-····-···--48
Trauma-informed Care . . . .. . .... ..... ·-· ·--··· .52
Self-injurious Behavior ... . . . ·- ........... ·-·. ·--·61
Common SIB Tendencies . . ... .. ... ..... ..... ........ . ···--· ·--·. .. 64
Sensory Modulation-related Assessment Tools............................... ..... 71

The Sensory Modulation Screening Tool -·. ... . ..... . ·-·. ·-· ·-·. . ·············-···············-· ...... ............ ....... . .... 75
Sensory Tendencies and Preferences Questionnaire . ·--· ·--·.... ·-··· ·-· ·-· ·-· ········-·. .... . ..... . . 84
Sensory Defensiveness Screening Tool: Adolescent/Adult . .... ·-···-·--.... .... . . ..... ...... . ........89
Caregiver Questionnaire .... ·-·..... ·-·. ···-··· ·-· ···-· ·-····· ·-··········.... . . . . ·-···. .... ........ .... . .... . .. .... .. .. ... ..... . 92
Chapter III - Sensory Modulation and Intervention.. ·--········· · · ·····. 95

A New Taxonomy in Sensory Processing ................... . ................ ....... . .... .... . .. ...... ·-·. ·-··· ···-··... . .. . ... 97
The Sensory Modulation Program ................. ..... . . .... ...... . .. .. . ...... ·-· · · ····--· ···· ·-···-· ·--· ·-··· ·-· ···. ..... . . .... 98
Sensory Modulation Program Goals . ............. . ........... ···-· ·-·-·····-···.... . ·-·-· ·-· ·--·--· ·-· ·-·...... ·-· ·........ .. . _ 105
A Therapist's Quick Reference to the Sensory Modulation Program Goals ... . .. 126
Broad and Deep Spiritual Occupation..... . ............. ·-·-·...... ...... ···-·. ·-·. ·-· ·-· ·-· . ·-· ·-· ·-·- ·-· ·-·-···....... . . 128
Sensory Modalities and Integrative Therapies . ·-· ···-· ··--· ·-··· ·-· ·--· ···-·--· ·-· ·-· ·-·-· ·-··· · ·-······ . 129
Weighted Modalities ..... .... . ·--···-·.......... . .......... . ·-·········· ·-··· ·--·. ·-···. . .... ·-· ···-· ···-· ·-·-·-·. ·-· ·-·.. . ·-·-·...... . ...... . . 132
Aromatherapy 139
Sensory Modulation Terminology and Therapeutic Activity Examples ·-·. ···-··-- __ _ 140
"Detective Work" .. . .. ................... ....... .. ........ ..... ...... . .... .... ... .... . ·-· ·-·. ...... · ··--·. ·-· ·--·-···--···-··· ·--· · ·······. .. .. 141
Contents v
Mental Health and Sensory Modulation Approach Suggestions ····-·. ·-··.... . ... . ·-··.. ·-·. ·-·.. 143
The Art of Integrating Therapeutic Approaches and Techniques .. ······-·· .... . ····-·. ·-·. . ·-·._ 148
Integrative Group Ideas .. ... .. ·-·-·-·-·--· ·---·--·····-···". . . � ............. ...... .... ·-····. ·-· ···-· ·--·.. ·-·. ·--···-151
Chapter IV-Environmental Modifications and Program

Enhancements . ·-· .. .. ....... ·-·. .. .... . ... ..... . ·-· · ·---· .. ·-·-· .... . .......... .. . . 161
Sensitivity to Initial Conditions 163
Environmental Influences . ...... ......... ... _ .• 163
The Sensory Room ···--···--·-···········" .. 166
Program Evaluation ··-·----··... ··-·..... .. . 172
The Sensory Room: Purpose, Benefits and General Precautions 174
Sensory Room Development ... 176
Making it Mobile: Carts, Suitcases, Baskets and Bins .. ...... . . .. ....... .... .
. 183
The Restraint and Seclusion Reduction Initiative ·-·. ............ .. . . 186
Code SAM (Sensory Approaches and Methods) .. ·---·. ····--·-·..... ...... . . 188
Seclusion and Restraint Reduction: The Big Picture . ..... .... . . . . . 196
Chapter V-Staff Training and Caregiver Education ·-··· ·-· ....... ....._.199
Training for Professionals ·-·-·-·.... ··· ···-···-··-·........ ....·······-··· ·-·. ·-· ·--· ·-· ·-· ·-· ·-·-·........... . ···-···--·--·····.. 201
Caregiver Education for Families, Friends and Significant Others _ ·--···-·. ·-·. · ·-·. . ···-··· .... 202
The Sensory Modulation Program: Training Tool . .... ... . . ·-·. ·-· ·-·. ·-· ·-· ·-· ·-·... . . ... ·-·-··. . . .... . . ... 221
A Therapist's Quick Reference to the Sensory Modulation Program Goals . ... ·-·.. ·-·. 228
Chapter VI-Resources ... 231

The Effects of the Use of the Sensory Modulation Room in Acute Inpatient
Mental Health Settings ... ·---·--·.... .......... ...... ···-· ·-·. . ·-. -·. .... . .... . ... . .. . .. ... ..... 233
The Quality Improvement Study 234
Sample Sensory Modulation Room Policy and Procedure .. ···-· ····. .... .. ........... ... 241
Sample Weighted Modality Policy and Procedure ·--- ·-··-····............ . .... .............. . ... 243
Vendors of Therapeutic Products and Equipment ·-·-· ---·-- · ·-·······-···-·--···-········-...... .. . . 246
Chapter VII-Glossary and References , • ••m·•······•··•••·-·•········-·••••·· -· ·249
Chapter VIII-Sensory Modulation Worksheets ......... . 265
vi Sensory Modulation & Environment· Essential Elements of Occupation

Table List
Table 1: Comparison of Classical Science and NonlinearScience ·········-· · ··-· ··--···-··· ·-··-· ··-···· ·-····. 4
Table 2: Intention, Meaning and Perception (IMP) . ·-·. .... . -·-··-·····--· ·-·· -······-·. ·· ·····-·-. ..... . .... . .... .... ····-·--·-· ·...... .... 8
Table 3: Parasympathetic Nervous System Branches........ ... . . -···. .... 15
Table 4: A Comparison of Views: A Nonlinear Dynamic vs. Sensory Integration Theoretical
Approach toSensory Modulation .... . . . ·-· ···· ·-·-· ·- ·--· ·--· ·-··· ·-··· ···· ·-· ··· ···-··· ·-···. . .... ...... ·-··-····-···-· ·-· ·-···.... 41
Table 5: Common Sensory Interventions: Order and Control Parameters .. ............ . 50
Table 6: Broad and DeepSpiritual Occupation . ... . ... ...... . ·-··-··-----··-·--...... ······-····.. . .. 129
Table 7: Techniques for Facilitating Change Processes..... .... ....... ·-·. ·-· ·-·. . ·-···. ·-·. ·---· ·--···--· ·-·. .. ......... .... . .... 151
Table 8: Rhythm = The "Pulse of Life" ·····-· ·--· --·--··-··· ·-·. . ... . . ....... .... ·-··········. ...... .... . . . ·····-···--·. 164
Table 9: TheAllen Cognitive Levels .. ... .... ·-·. . . .. . .......... .... . ... . 236
Table 10: Average ImprovementWhen the Client's "Before" RatingWas between 10 and 8
Using a 0-1 O Scale: n = 5.3 . ·-···. ... ·-·. ·-· ·-··--·. . ... ·-· ·-··· ·-···. .... .. ... . ..... .... .. .. .. . . . ... ... ... ..... ·-· ·--· ...237
Table 11: Average Improvement When the Client's "Before" RatingWas between 7 and 5
on the 0-10 Scale: n =3.2 .. .. ... . .... . .... ........ .... -· .. ... ... ·-·... ·-· ·-·-· ·-·..... ... . 238
Table 12: Average Improvement When the Client's"Before" Rating Was between 4 and2
on the 0-10 Scale: n = 2 2. .... ........ .. . .... .... ... .. ..... .. . . .. . ........ 239
Figure List
Figure 1: TheMathematical and Scientific Roots of theStudy of Complex AdaptiveSystems --·.. ···-·. .. .... 6
Figure 2: The Circular Causality of Attractor Strengthening ·· -·-··· .... . .... ... . . . ......... . . . . . _ ...... . .... ·-· ___ 11
Figure 3: Spirit-Mind-Body-World .... . . .. . .. .. ........ . .... ........ ... _ 20
Figure 4: Sensory Processing Disorder (SPD): An Umbrella Term-··-· ·-···. . ...... ·-····· . . ............ .... . .... ... . ·-··-··-···---.39
Figure 5: A Continuum of Hypo- and HypersensitivityTendencies ·-·.. . ............... . . .............. . ..... 49
Figure 6: Autonomic Nervous System Arousal Patterns and Correlations toSensory Modulation
and theWindow of Tolerance Scales . . ............. . .... ·····-·. ...... . . ........ ·-·. ·-·. ·-· ·-·. .... .. . . 56
Figure 7: Sensory Processing Disorder (SPD): An UmbrellaTerm -·............... ········-·······. ____....... ... .... ..... ·-·-··· ·-· ·-·.97
Figure 8: Sensory Rooms: An Umbrella Term · .... . ·-··-···............. ··-·. .. .... .. . ............. .... . 167
Figure 9: Example of Escalation of Anxiety . ·-·. ····-·..... .................. ...... ········-· ·-· ...... . . 196
Table and Figure List Vii

Resources Included on the CD
1 Sensory Modulation-related Assessment 5 Self-rating Tool - Levels of Alertness
Tools 6 Self-rating Tool - Relaxation Techniques
1 The Sensory Modulation Screening Tool 7 Self-rating Tool - Self-soothing
2 Sensory Tendencies and Preferences Techniques
Questionnaire 8 Art Expression
3 Sensory Defensiveness Screening Tool: 9 Calming or Alerting
Adolescent/Adult 10 Colored Glasses
4 Caregiver Questionnaire 11 Creating a Personalized Sensory Kit
2 Allen Caregiver Guides 12 Distress Tolerance Checklist
1 Allen Caregiver Guide Cognitive Level 2 - 13 Exploring Problem Areas and
Sensory Diet Guide Corresponding Strategies
2 Allen Caregiver Guide Cognitive Level 3 - 14 Exploring the Senses - What is Soothing
Sensory Diet Guide to You
3 Allen Caregiver Guide Cognitive Level 4 - 15 Grounding Techniques
Sensory Diet Guide 16 Grounding Techniques - General
4 Allen Caregiver Guide Cognitive Guidelines and Worksheet
Levels 2.4-2.8 17 Guided Imagery - Footsteps
5 Allen Caregiver Guide Cognitive 18 Guided Imagery - Road
Levels 3.0-3.4 19 Guided Imagery - Sailboat
6 Allen Caregiver Guide Cognitive 20 Guided Imagery - Tree
Levels 3.6-3.8 21 Heavy Work Activity Brainstorming Sheet
7 Allen Caregiver Guide Cognitive 22 Mindfulness - Vision
Levels 4.0-4.4
23 Positive Affirmations
8 Allen Caregiver Guide Cognitive
24 Sense-abilities
Levels 4.6-4.8
25 Sensorizing Your Sensory Kit
9 Create Your Own Personalized
Sensory Diet 26 Sensorizing Your Wellness Toolbox
27 Sensory Diet Exploration - Activity
3 The Sensory Modulation Program - Checklist
Training Tool 28 Sensory Diet - Crisis Intervention
The Sensory Modulation Program - Worksheet
Training Tool 29 Daily Schedule and Sensory Diet -
Discharge Planning
4 Sensory Modulation Worksheets
30 Sensory Modulation - Self-rating Tool
1 My Daily Tendencies - Self-rating Scale
31 Sensory Modulation
- Levels of Alertness and Sleep Patterns
32 Shaping Up Your Self-talk Habits
2 Generic Self-rating Tool
33 Symptoms Resulting from Intense
3 Biodot Self-rating Tool
Emotions
4 Self-rating Tool - Distress Tolerance
Techniques
vUl Sensory Modulation & Environment: Essential Elements of Occupation

Philosophy,
Science and
Occupational
Therapy
Classical and Nonlinear Science: A Comparison
ofViews
The profession of occupational therapy (OT) emerged during the progressive era (1980-
1913). Its mission was "not the making of a product but the making of a MAN, of a man
stronger physically, mentally and spiritually than he was before" (Barton, 1920, p. 308;
Peloquin, 1991). The earliest philosophical premise recognized occupation as having a
positive influence on physical, emotional and spiritual well-being (Hall, 1910; Meyer, 1977;
Reilly, 1962). This fundamental premise significantly influenced all aspects of the profession
in its early development. The conglomeration of pragmatic, existential, and humanistic
roots led to the recognition of the centrality of occupational engagement to health, wellness,
and the recovery process. These philosophical principles also influenced the deeply client
centered nature of occupational therapy and the belief in the role of the occupational
therapist as a facilitator of change, and of the client as change agent.
Similar to other social science and health professions, however, the expectation and
movement to become more scientifically established within the medical model led to the
application of the classical scientific and research methods of the physical sciences. Classical
scientific approaches are also referred to as linear, reductionistic, mechanistic or Cartesian,
as brought to the forefront by Rene Descartes (Capra, 1996). Although the use of classical
approaches has led to many advancements over the years, their reductionistic influence
on the deep philosophical core assumptions of occupational therapy ultimately led to
fragmentation in many of the profession's theoretical frameworks and practices. This is true
not only of occupational therapy, but also across the health professions.
Additionally, the sole application of reductionistic assumptions and methodologies to
the study of dynamic human systems greatly diminished the deep appreciation for the
interconnectedness and interdependence of the spirit-mind-body-world relationship. As
a result, a fundamental shift in core beliefs and practices emerged. Some of these changes
included the comparison of the human system to a machine, the nature-versus-nurture
debate, and the subjective-objective and internal-external environmental dichotomies.
Further, the linear input-throughput-output models of cognitivists and the stimulus
response paradigms of behaviorists became some of the primary models of mind. Ultimately,
the core philosophical and theoretical premises of occupational therapy and the other
healthcare professions changed in many ways that continue to remain evident. These issues
emerged largely because the technological and statistical methods available in the past were
not capable of fully capturing or demonstrating the dynamic nature of human systems or
the human system change process and, therefore, of OT practice.
The advent and application of general systems theory (GST) (von Bertalanffy, 1968) aided
many OT and healthcare scholars to begin applying a systems approach (Kielhofner & Burke,
1977). In fact, many of the OT frameworks still used today have been significantly influenced
by GST. While helpful in the efforts to get back to our dynamic core values and roots, GST
only afforded the ability to begin this paradigm shift. Advancements occurring in the scientific
fields of brain imaging, computer systems, mathematics, physics and, nonlinear scientific
theories and methodologies, support the ability to study and better understand human
system complexity, change and relational processes. The current expansion and application of
nonlinear scientific advancements will help to further establish and validate the authenticity
and dynamic nature of the human system change process, occupational therapy and other
holistic healthcare practices.
I Philosophy, Science and Occupational Therapy 3

Table 1 demonstrates some of the differences between the classical and nonlinear scientific
schools of thought. Consider how each contributes to and ultimately deeply impacts how
we think about and study occupation and occupational therapy practice.
Table 1: Comparison of Classical Science and Nonlinear Science
Classical Science Nonlinear Science

Linear (reductive) Nonlinear (dynamic/complex)
t-
Objective Includes subjective
----
Isolated events/objects/parts
-- -- Context sensitive; relational focus
Focused on stability Focused on sensitivity
�
Closed system Open system
Predictable (determinism) Unpredictable (probability patterns)
Time uniformity/fixed states Sensitive to critical periods/process
--
ause and effect: Linear input- Cause and effect: Circular causality and spiral causality
uhroughput-output
Meehanisti c/control-based Self-organizing

I
Occupation: product vs. process Occupational experience as process giving rise to product, 1
which through circular causality becomes new process _J
Shallow Ecology vs. Deep Ecology
In the 1970s, in addition to general systems theory, the Norwegian philosopher Arne Naess
distinguished between shallow and deep ecology {Capra, 1996}. Shallow ecology, according
to Naess, views human systems as separate from all other living systems within the larger,
dynamic context of the natural environment. This suggests that there are boundaries between
human systems and all other living and nonliving things, leading to the fundamental view
that human beings are autonomous in nature.
Conversely, deep ecology does not separate human beings or anything that is within the
environment as being totally distinct from it. Deep ecology considers all that is of the world,
including human beings, as a network of phenomena. According to Capra (1996), "all living beings
are members of ecological communities bound together in a network of interdependencies.
When this deep ecological perception becomes part of your daily awareness, a radically new
system of ethics emerges" (p. 11}. Ultimately, "linked", if you will, dynamic human systems are
viewed as fundamentally semi-autonomous. This heightened awareness validates the need
to recognize the potential influence of the physical environment, all verbal and nonverbal
interactions, and other therapeutic interventions. All of these variables may significantly
influence individuals, no matter how brief, complex, significant or seemingly insignificant the
environmental exchanges may seem. Consider the potential applications to practices in mental
health and to healthcare services in general. Such a view helps to support the importance of
exploring mind-body and integrative therapies and the influence of the physical environment,
to name a few. Consequently, the potential scope of the studies of cognition, sensory processing,
and mental health issues and therapies becomes considerably broadened, and the dynamic link
to occupation can be more deeply appreciated and potentially validated.
4 Sensory Modulation & Environment: Essential Elements of Occupation

Further, when using a deep ecological approach, the intrinsic value of all living systems
is emphasized and the dynamic human system is seen as just one particular strand in the
entire web of life (Capra, 1996). A deep ecological approach equally recognizes the whole,
the part and the greater whole, placing life and occupational experiences at the very core.
Capra and Steindl-Rast (1991) describe the human spirit as the mode of consciousness
where a person feels a sense of connectedness and belonging to the universe. This further
suggests that having such a deep ecological awareness is quintessentially spiritual in nature
(Capra, 1996).
Nonlinear Dynamic Systems, Chaos and Complexity Theories

Over time, nonlinear science has emerged, giving rise to nonlinear dynamic systems
theory, chaos theory and complexity theory, among others. Nonlinear science also uses a
specific taxonomy, some of which will be reviewed and applied throughout this handbook.
Nonlinear dynamic systems theory views human beings as open, chaotic and self-organizing
systems (Capra, 1996; Freeman, 2000a). Living systems are open in that they would not be
able to thrive without the dynamic "environmental" exchange process of matter, energy
and information. Nonlinear dynamic systems theory is the "grandfather" of chaos theory
(Goldstein, 2006), which recognizes no individual properties of any part of a living system
as being fundamental. Instead, all that follows from a dynamic system's parts, its overall
consistency, and its dynamic interconnectedness and interrelatedness, contributes to the
structure of the entire web (Capra, 1996).
Self-organization
"Self-organization and change" refers to the emergent structures, patterns and properties
arising in the brain and is a fundamental characteristic of the brain (Abraham, Abraham &
Shaw, 1990; Freeman, 1995; Haken, 1983; Kauffman, 1995; Kelso, 1999). According to nonlinear
science, this process is not externally controlled (Gleick, 1987; Lorenz, 1993); rather, the
process of self-organization may be influenced. According to the study of neurodynamics,
one of the ways that self-organization is evident is in the process by which local interactions
of neural activity create dynamic states of global order and coherent behavior (Abraham,
Abraham & Shaw, 1990; Freeman, 1995; Haken, 1983, 1984). Further, self-organization and
positive change are typically viewed as helpful to the system and apparent in the process of
self-healing, when learning a new skill, or in the ability to shift one's emotional state. Self
organization in human systems, however, can also be viewed as negative in nature, as seen in
addiction or in the growth and spread of cancer. Hence, it is necessary to underscore that the
process of self-organization in living systems can lead to what is viewed as either positive or
negative change in a system's health and quality of life. In occupational therapy, the charge is
to facilitate the process of self-organization and positive change.
It is also important to emphasize that when applying a nonlinear dynamic scientific approach,
occupation is viewed as both process (e.g., neurodyamics) and product (e.g., human behavior,
task performance, engagement in purposeful activities). In this view, occupation emerges
from chaotic interplay that is open, embedded in the world, self-organizing, sensitive to
initial conditions and always "becoming" (Freeman, 1995, 2000a; Lazzarini, 2004; Nicolis &
Prigogine, 1989).
Chaos theory also deeply promotes the interdependence and interconnectedness of living
systems and is applied in the physical and life sciences (Capra, 1996; Gleick, 1987). Due to
this interrelatedness, "chaos" and "nonlinear dynamics" are terms that are sometimes used

interchangeably. When questioning whether a system is chaotic, you need only ask one question:
"Is this system unpredictable?" If the answer is "yes", it is probably a chaotic, self-organizing,
nonlinear, far-from-equilibrium system. An additional quality necessary for a system to qualify
as being nonlinear is that it must contain attractors {Goldstein, 2006). Attractors can be described
as "a set of physical properties toward which a system tends to evolve, through emergence,
regardless of the starting conditions of the system" (American Heritage Dictionary, 2009).
"Emergence" refers to the self-organization and rise of coherent and novel properties, patterns
and structures in complex systems (Goldstein, 2006). Additionally, when trying to study the host
of complex variables involved in a dynamic relationship of an organism and its environment,
complexity theory often proves useful. Jantsch (1980) proposes:
... complexity marks an open evolution which reveals ever new dimensions of
novelty and exchange within the environment. It is not adaptation to a given
environment that signals a unified overall evolution, but the co-evolution ofsystem
and environment at all levels, the co-evolution of micro- and macrocosms. (p. 75)
Chaos and complexity theories are rare exceptions in that they are used to study and help
describe both inherently stable and inherently unstable systems {Butz, 1997). Typically,
theories are used to describe either one or the other type of system. Stable systems are those
that are not likely to change, whereas unstable systems are those that are in the process of
changing or where change is imminent (Butz, 1997). In order to utilize complexity, chaos
and/ or nonlinear dynamic systems theories when studying or working with dynamic human
systems, phenomenology, epistemology and the use of approximate knowledge becomes
integral. Figure 1 was created by Jeffrey Goldstein, Ph.D., of Adelphi University, and is provided
to illustrate some of the primary historical bodies of knowledge influencing the evolution
of nonlinear scientific approaches used to study complex adaptive systems, such as human
systems (persons, organizations, populations).
Figure 1: The Mathematical and Scientific Roots of the Study of Complex Adaptive Systems
SYSTEM DYNAMICS
CATASTROPHE
THEORY SELF-ORGANIZED
'CRITICALITY' _--
DYNAMICAL \
SYSTEMS '- N ONLINEAR DYN
GENERAL SYSTEMS AMICAL
THEORY FRACTAL / SYSTEMS (NDS)
GEOMETRY CHAOS THEORY
OLIDSTATE/
ONDENSED MATTER ---..;:::...;:,, ARTIFICIAL LIFE-.....;a---.-.-�_ COMPLEX ADAPTI VE
_.._
HYSICS SYSTEMS (CAS)
EV OLUTIONARY EMERGENT COMPUTATION
BIOLOGY BOOLEAN NETWORKS
CYBERNETICS ::---.... EVOLUTION
ARY
'\.._ -, SYSTEMS GENETIC ALGORITHMS
\ '- AUTOPOIESIS
INFORMATION ARTIFICIAL ---..._
��!,CrI
THEORY '- INTELLIGENCE # COMPUTATIONAL
� THEORY
NEURAL NETS
GAME THEORY SYNERGETICS
---- FAR-FR OM-EQUILIBRIUM

THERMODYN AMICS
© J. Goldstein (2006); printed with permission.

Consider the applications to the study of therapeutic exchanges, human system change and
healthcare system (organizational) change. Nonlinear science is also being used to study
how systems are coordinated and how the process of coordination leads to function or the
lack thereof.
According to Kelso {1999), coordination is:
... how things are put together to produce recognizabkfunctions. The things
themselves might be made of matter, such as neurons, muscles, parts of the body,
or they might be mental "things" such as perceptions or ideas. Coordination,
I argue, is a fundamental feature of life. Imagine a living system composed of
components that ignored each other and did not interact with themselves or the
environment. Such a system would possess neither structure nor function. (p. xi)
Thus, it is essential to recognize that human system dynamics change over time and are
fundamentally interconnected, interdependent and coordinated, which is essential to life
and therefore to human occupation. Additionally, Kelso states (1999):
As the classic dichotomy between structure and function fades, and we begin to
sense the intimate relation between them, all we are 'left with is dynamics, self
sustaining and persisting on several space-time scales, at all levels from the single
cell up. (p. 15)
Thus, applying nonlinear dynamics requires this fundamental change in the way we view
dynamic systems and the dynamic system change process. It also influences a profound
change in the approach to both practice and research, ultimately influencing the culture
and the quality of care.
Padilla and Peyton (1997) point out that, although reductionistic methods may be helpful
for scientific advances, problems arise when solely applied to the study of human systems
and to OT practice. More recently, however, OT scholars have included the use of nonlinear
dynamic systems theory in various frameworks and publications (Champagne, 2006, 2008;
Ikiugu, 2007; McLaughlin, Kennedy & Zemke, 1996; Lazzarini, 2004, 2005; Lohman & Royeen,
2002; Royeen, 2002, 2003; Spitzer, 1999). These works demonstrate that already, nonlinear
scientific theories and principles are being utilized by many OT professionals.
Intention, Meaning and Perception (IMP)

As we have established, human beings are self-organizing systems, constantly learning,
growing and becoming through the process of self-organization. Intentionality is the
stretching forth of the human system in a goal-directed manner. According to Freeman
(2003a), "the process by which meanings grow and operate is intentionality". Intentionality
is also a self-organized process, motivated by meaning and/or novelty {Freeman, 2000a).
Additionally, according to the study of neurodynamics, the self-organization of voluntary
actions is the product of previous experience, the dynamic states of arousal and attention,
and the individual's expectancies of responding to stimulation, context and intentionality
(Freeman, 2000a; Lazzarini, 2004). Human systems have neuroplasticity, supporting the
ability to form new attractor patterns (habits) across the lifespan. This is evident even on
the level of intentionality, where it is seen in individuals even when dementia or other
neurological impairments are present. Thus, intentionality is an important part of the
multidimensional process of occupation and warrants further research.
I Ph losophy, Science and Occupational Therapy 7

At the microscopic level, activity is expressed by action potentials and is sensory informed
and intentional (Freeman, 2000a). At the mesoscopic level, the collective activity of
neurons creates neural populations. The sensory-driven action potentials condense into
spatiotemporal activity, which creates wave packets {Freeman, 2000a}. Wave packets are
often studied using electroencephalography {EEG), and are revealed as oscillations in brain
potential, often referred to as bursts. It is at the mesoscopic level, which encompasses the
limbic system, that meaning and emotion emerge (Freeman, 2000a}. The macroscopic level
is where perceptual awareness emerges (Freeman, 2000a). The activity of the macroscopic
level is that of the entire forebrain, which is often expressed through communication and
by the actions and behaviors we observe (Freeman, 2000a}. In addition to these hierarchical
levels, there are feedback loops between the levels, through which a heterarchical process
takes place. Also, each hemisphere and section of the brain (lobes} contributes in different
ways to support the ability to function.
Table 2 provides an introduction to the terms "intention", "meaning" and "perception" as
used in the IMP model.
Table 2: Intention, Meaning and Perception (IMP)
I Intention Goal directedness emerging within and from the brain

(Microscopic level) Key structure: Brainstem level
Key function: The self-organization of homeodynamics
I
An emergent process that evolves as the brain creates wave packets,
I--
largely resulting from sensorimotor experiences

Meaning
(Mesoscopic level)
Key structure: Limbic system level
Key function: Meaning-making
The self-organization of sensorimotor information and meanings, through

the creative process of large masses of coordinated neural populations
Perception
(Macroscopic level)
Key structure: Cortical level
J
Key function: Awareness
Lazzarini et at. (2007); adapted from Lazzarini (2004). based on Freeman (2000a).
Neuro-occupation and IMP

The term "neuro-occupation" is an amalgamation of works from nonlinear science,
neuroscience, occupational therapy and occupational science (Lazzarini, 2004, 2005;
Lohman & Royeen, 2002; Padilla & Peyton, 1997; Royeen, 2003). Lazzarini (2004, 2005)
expanded the model of intention, meaning and perception (IMP} initially created by Freeman
(2000a) and applied it to occupation and OT practice in an attempt to further develop the
model of neuro-occupation (Champagne, Ryan, Saccamanto & Lazzarini, 2007; Lazzarini,
Champagne & Luby, 2007; Royeen, 2003). The IMP model helps demonstrate how human
beings change over time through occupation (as process and product}. In this nonlinear
view, habit formation (pattern formation) is referred to as learning, and may be viewed
across different scales (e.g., neurological, emotional, behavioral, spiritual). Circular causality
differs from linear causality and demonstrates the complexity of the human system change

process, through multiple feedback loops and across scales (Freeman, 2000a, 2000b), as in
the IMP model.
As complex dynamic adaptive systems, human beings continually experience transforming
exchanges across multiple scales. How a system is able to persist under environmental
conditions reflects its flexibility (or fitness). also referred to as its degrees offreedom. Many
assessments are used to explore the flexibility of the system. Generally, the more flexibility
or degrees of freedom the system possesses, the more options and challenges (complexity)
it can handle. How an individual adjusts, or has difficulty in adjusting, to ever-changing
environmental (internal and external) conditions reflects his or her degrees of freedom
(adaptability) or lack thereof. Nonlinear approaches can help to describe occupation as
an intentional, self-organized process. Flexibility, pattern formation and coordination are
dynamic processes that help to support the system's ability to function. Kelso ( 1999) applies
Haken's concept of synergetics to substantiate that human systems are
... fundamentally pattern-forming, self-organized, dynamical systems poised on
the brink ofinstability. By operating near instability, the brain is able to switch
flexibly and quickly among a large repertoire of spatiotemporal patterns ....
When the brain switches, it undergoes a nonequilibrium phase transition, which,
according to Haken's theory, is the basic meclianism of self-organization in
nature. (p. xvii)
Although dynamic systems are self-organizing, a host of problems may arise that interfere
with the ability to function. Self-organizing systems may become injured {e.g., through trauma
or disease), or may appear "stuck" at times (e.g., severe depression or addiction). And when
tension or damage occurs, the emergent system adapts. Depending upon the severity and
nature of the influence, the system may employ any number of self-organizing mechanisms,
such as creating new spatial patterns within the brain, attacking destructive "invasions", or
creating new patterns of growth. When turbulence emerges (e.g., too much instability), or
shifts occur that create a less flexible or adaptive state, a change in behavior is often observed.
Butterfly Effects: Sensitivity to Initial Conditions

Cybernetics, catastrophe, complexity and chaos theories all have a common goal: they
strive to explain complex systems consisting of a large number of mutually interrelated
and interdependent parts in terms of relational interactions. Henri Poincare (1854-1912),
otherwise known as the "father" of chaos theory, published Science et Methode in 1908.
This work stated that chance is a determining factor when studying dynamic systems,
due to the possibility of unknown initial variables or conditions. In his studies on how to
make predictions about the earth, moon and sun, Poincare was the first to discover a flaw
in Sir Isaac Newton's laws. He found that the slightest influence in the initial conditions
of nonlinear systems may in fact produce significant changes. In this way, he recognized
that making predictions regarding dynamic systems is not reliable. Similarly, occupational
therapists know that a change in initial conditions (e.g., physical environment) can have
a small or large influence on a person's ability to function and on their recovery process.
Hence, dynamic human systems also demonstrate sensitivity to initial conditions.
Edward Lorenz used Poincare's mathematics to create and interpret a mathematical model
of a weather system. Lorenz referred to systems exhibiting this sensitivity to initial conditions
as having a "butterfly effect". He proposed that if a butterfly flapped its wings in one
geographical location, it may impact the course of the weather in another; therefore, small
I Philosophy. Science and Occupational Therapy 9

changes in one or more variables may result in large effects. In practice, this view validates
how at times we may notice that a seemingly small variable can facilitate a significant
change. Lorenz concluded that there is no way to predict consistently the behavior of
nonlinear, chaotic systems, since they are sensitive to initial conditions and demonstrate
instability in form, function or both (Gleick, 1987). In practice, we must recognize that we
are unable to predict fully how human systems change. Rather, when hypothesizing about
therapeutic outcomes, it is generally more appropriate to consider probabilities of change.
Further, practitioners and consumers can collaboratively capitalize on sensitive dependence,
and use it to facilitate increased system flexibility (health)-for example, facilitating the use
of the weighted blanket as a preparatory intervention to promote the ability to rest or sleep.
When applying a nonlinear dynamic systems approach, all aspects of one's practice will
begin to reflect its essence. In becoming more aware of these deep philosophical and
scientific principles, we begin to understand our role as facilitators of self-organization and
positive change, and to see how even seemingly small or subtle influences may have a small
or large impact on human occupation.
The "Edge of Chaos" and "Degrees of Freedom"

Being at the "edge of chaos" is a phrase used to describe when a chaotic (dynamic) system
is at an optimal dynamic state for the task at hand. It is here that people demonstrate
the creativity and flexibility to switch dynamic states. The term "degrees of freedom" is
used to describe a system's degrees of flexibility. One's degrees of freedom influence one's
ability to learn and adapt. All human beings encounter continuous internal and external
perturbances. These perturbances may be positive and/ or negative, and we may be aware
or unaware of them in context and time.
The ability to self-organize and adapt is one that most people take for granted. Noxious
smells, a person brushing against you in the grocery store, tags in clothing, or even a simple
car ride, are types of stimulation that most people are able to tolerate or adapt to. We may
have the ability to perform in a competitive work situation and then flexibly "switch gears"
as we drive off to yoga class after work. Not everyone, however, has this degree of flexibility
(degrees of freedom), and this ability is one that changes over time.
Butterfly Power
As practitioners trying to influence some sort of movement or positive (healthful} change
within and among dynamic human systems, it is necessary to utilize philosophical and
theoretical approaches that embody the dynamic nature of human systems and therapeutic
exchanges. Hence, combining concepts from nonlinear frameworks affords the ability to
more deeply understand and research human occupation and change. In this way, a deep
and robust appreciation emerges of how cooperation, coordination, pattern formation,
flexibility and butterfly effects are some of the key variables in all therapeutic exchanges
and throughout one's long, life-journey of learning (e.g., sensorimotor learning, academic
learning, recovery process).
"Physici.sts like to think that all you have to do is say, 'These are the conditions.
Now, what happens next?"'
- Richard P. Feynman

Habits: Dynamic Boundaries in the Evolution of
the Self
Habits are learned patterns (attractors) that, when performed, require little energy and
thought, and often occur in a seemingly automatic manner. Habits or attractors can be
viewed on a variety of scales ranging from the level of neuronal pattern formation through the
level of human behavior. Further, given their interrelated and interdependent nature, habits
(attractors) on one level (or scale) may participate in the creation of tendencies evidenced on
another level. In non-linear dynamic, chaos and complexity theories, there are different kinds
of attractors (e.g. fixed-point, limit-cycle and strange attractors).
Further demonstrating the complexity of habit or pattern formation, a human system also
demonstrates multi-stability. Multi-stability within a dynamic system refers to one's ability
to have many attractors coexisting at the same time, each attractor having its own basin of
attraction (Kelso, 1999). The basin of attraction is the area surrounding the attractor pattern
that pulls the system toward the attractor. Multi-stability affords the ability to have many
options or collective dynamic states when confronted with a control parameter (Haken,
2002, 2003). Once a deep attractor is formed, habitual hypothesis testing facilitates a private,
subjective feeling of familiarity, stability and predictability (Freeman, 2000a; Kelso, 1999). This
is evident, for example, when performing one's morning routine or driving along a familiar
route. These familiar activities are often performed in a seemingly automatic manner,
requiring less-focused attention than when performed in a new way or in a new context.
Figure 2 is a simplistic representation of the nonlinear dynamic process of the circular
causality of habit strengthening, whereby meaningful continuous habitual experiences
produce a deepening of the basin of attraction, leading to attractor stability (Champagne,
2006a; Lazzarini et al., 2007).
Figure 2: The Circular Causality of Attractor Strengthening
:··········
••
•••
.. Habitual
Experience
'
• •••••••••••••
•
Habitual
Experience •····················· Habitual
Experience
People become dependent upon habits because they provide subjective feelings of familiarity
and the neurodynamical boundaries that "support our daily patterns of occupational
engagement" (Zemke, 1994, p. 5). Little effort is required to engage in habitual tasks unless
an unforeseen issue or novel influence arises. Moreover, trying to change a habit may feel
uncomfortable and typically requires conscious effort on the part of the learner.
t Philosophy, Science and Occupational Therapy 11

Habits, Roles, Rituals and Routines: Occupational Performance Patterns
Occupational performance patterns of human behavior evolve over time and are evaluated
in occupational therapy practice. These patterns are often recognized by occupational
therapists as habits, roles, rituals and routines (AOTA, 2008). Habits, roles, rituals and
routines are deeply meaningful and provide the foundation necessary to support engagement
in meaningful activities. When impoverished or dominating, however, occupational
performance patterns may impede occupational participation, health and the recovery
process (AOTA, 2008). Habit formation is analogous to pattern formation, which is apparent
across all levels of organization within dynamic human systems. Occupational Therapy
evaluation, therapeutic interventions and outcomes measurement are attempts to assess
dynamic human system tendencies and patterns in order to facilitate positive change, when
to do so would be beneficial to the individual. The OT process encompasses the clinical
reasoning and methods used by occupational therapists to explore each person's dynamic
patterns, and their ability to transition flexibly between dynamic states (adapt) and to
facilitate positive change (e.g., occupational participation, health and recovery).
Therapeutic exchanges may help to create new and/or to destabilize existing habitual
patterns. An example of the creation of new patterns is the learning of new coping skills
requiring the destabilization of some existing patterns, which is necessary to stop or change
habits such as engaging in self-injurious behavior. Understanding the nonlinear dynamical
process of the circular causality of habit formation helps occupational therapists understand
the functional purpose and neurodynamics involved in habit formation (change process).
This knowledge enhances the ability to co-create therapeutic interventions leading to
positive and meaningful therapeutic outcomes. Further, the study of synergetics explains
pattern formation as the cooperation or coupling of the parts of an open, non-equilibrium,
dynamic system through the self-organizing process of circular causality (Haken, 1984, 1988,
2002; Kelso, 1999; Freeman, 2000a, 2000b).
The dynamic formation of an attractor, or habit, is through attractor pattern formation. Thus,
the circular causality of attractor or habit formation happens through repeated, self-organized
habitual experience (occupational experience} in space and over time. Genetic predispositions
may also play a role in attractor formation. This is evident in the example of sensory defensiveness
(SD). Some people have the genetic predisposition for SD, and others acquire it as a result of
their life experiences, while still others' genetic predisposition may have been further intensified
or lessened as a result of their life experiences (e.g., trauma or therapy}.
It is widely recognized that it is often necessary to use repetition in order to help an individual
develop a new habit. This dynamic process occurs through trial-and-error hypothesis testing,
leading to the assimilation of the sensorimotor consequences experienced and, ultimately,
to the creation of new meanings (Freeman, 2000a; Lazzarini, 2004). The active development
of a meaningful coping skill repertoire is one example of the process of habit formation
leading to the creation of new meanings and occupational performance patterns. Repetition
is often used to strengthen and stabilize the new habit or attraction pattern.
Thus, the circular causality of attraction or habit formation is a meaningful and self-organized
(conscious or unconscious) process continually shaping the entire attractor landscape.
This process contributes to pattern strengthening and stability, which is often behaviorally
observed and described in a myriad of ways. Thereby, attractors are often evidenced as
system-wide patterns that may be viewed as either positive {healthy) or negative (unhealthy)
in nature, and as stable or unstable.

Routines and Rituals
A routine is a repeated series of habits, continuously self-shaped in space and time, further
strengthening or deepening the attractor layout. Routine formation is through repeated
engagement in meaningful, habitual, occupational experiences. Routines often include rituals
(those profoundly meaningful and particular things one uses and/or the ways one engages in
activities). "Ritual is distinguished from day-to-day routine by its connection to the symbols,
beliefs, and values of the social group" (Crepeau, 1995, p. 6). Habits, routines and rituals afford
the ability to perform sequences of activities quickly and with ease. Similar to habits, people
become dependent upon routines and rituals. Hence, perturbances may lead to a decreased
ability to engage in the world in a smooth, comfortable and flowing manner. This is evident
when trying to make a change in our daily routines.
Perturbation and Bifurcation

The stronger an attractor layout becomes, the deeper and wider (more entrenched) is the
basin of attraction and the more difficult it is to change. Smoking, substance abuse and
other forms of self-injurious behavior are examples of habits (attractor layouts) that are
usually very difficult to change. Since human beings are sensitive to initial conditions,
attractor layouts may be influenced through perturbation and bifurcation. Perturbation is
a disruption of some kind that may create a critical fluctuation in a system's pattern(s), and
may be viewed as positive and/ or negative in nature. Bifurcation refers to a destabalisation
of the basin of attraction leading to a qualitative change in an entire attractor layout {Kelso,
1999). Occupational therapists often use therapeutic exchanges to facilitate a system
perturbation. When used in this manner, the term "perturbance" refers to the process of
influencing a deviation in the behavior of a system. Use of a novel activity, changes to the
physical environment, grading the difficulty of activities, and caring forms of confrontation
are examples of how perturbance may be used therapeutically, impacting occupational
performance skills and patterns.
Perturbance is also used in the assessment process, when exploring the flexibility (degrees
of freedom) of the system. In this way, perturbance is used to assess system instabilities
or tendencies (Kelso, 1999). For example, because all human beings are sensitive to initial
conditions, when one's morning routine is perturbed, disruption typically occurs. When
perturbed, feelings of fear, anger or surprise, may result. In the case of morning routine
perturbation, the individual may experience a mild irritation or the disruption of their entire
morning, depending upon the variables involved. When the client and the occupational
therapist consider the perturbing or bifurcating effects of symptoms of mental illness,
it becomes easier to appreciate how this may influence an individual's ability to engage
in meaningful life roles and activities. Perturbation, however, can also be helpful, rather
than disruptive (e.g. use of a calming intervention when stressed). The therapeutic use of
alerting activities to distract from cravings, the development and use of a "sensory diet", and
collaboratively considering environmental modifications are additional examples of how the
nonlinear principles of perturbation and bifurcation are applied using sensory modulation
approaches in practice.
Critical fluctuations are instabilities that are "hypothesized to be one of the generic mechanisms
for flexible switching among multiple attractor states; that is, for entering and exiting patterns
of behavior" (Kelso, 1999, p. 45). Critical fluctuations are sometimes viewed as "windows of
opportunity" when a person becomes willing to try to change a habit or when change begins to
occur. Critical fluctuations are often seen in practice when individuals experience life events that

lead to the desire to change and throughout the recovery process. Additional examples include
changes in activity performance, the ability to relate to others, and the ability to flexibly shift
dynamic states of attention in the midst of a myriad of environmental demands.
The Stress Response and Homeodynamics

In 1939, Dr. Walter B. Canon was one of the first to clearly articulate and promote the concept
of homeostasis, linking the mind-body again after years of separation. Canon referred to
the fight-or-flight response as an "emergency reaction". Canon's work, and that of Franz
Alexander (1960), led to the roots of psychosomatic medicine. Hans Selye {1956) built upon
the scientific work available on the mind-body connection, furthering the conceptualization
of the stress response. Selye's work promoted that the mind and body are linked and that,
therefore, psychological stress may manifest as somatic abnormality influencing one's ability
to function. In this view, "stress response" refers to the physiological changes that occur
when faced with stress or a threat (real or imaginary). Given the early scientific support
by the medical community, psychophysiology grew as a scientific field focused on the
mind-body connection. Many scholars continue to work on establishing this connection
as a focus within the scientific community. Candice Pert (1997) teaches that the nervous
system (including the brain) is interconnected throughout the entire body so intimately that
it is inaccurate to refer to the mind and the body separately. Freeman (2000b) proposes a
nonlinear dynamic approach, which he refers to as nonlinear neurodynamics, which furthers
and supports the varied works exploring the broader spirit-mind-body-world connection.
It is importantto point out that the term "homeostasis" focuses primarily on physiological
processes that change in response to an experiential process. The stress response is said to
activate three primary communicating systems that influence homeostasis: the voluntary
nervous system, the autonomic nervous system and the neuroendocrine system. These
systems work together to prime the human system to respond to real or perceived threats
and to maintain itself.
The autonomic nervous system (ANS), which includes the sympathetic nervous system (SNS)
and the parasympathetic nervous system (PNS), is often reviewed in discussions related to
the stress response and sensory processing. The SNS is involved in activating the system in
stressful situations and influences system-wide changes to enable the individual to respond
effectively to the threat or danger. Some of the changes produced by the SNS response
include increases in heart rate and respiration, pupil dilation, secretion of catecholamines
from the adrenal gland, and the inhibition of smooth muscle activity in the digestive system.
The activation of the SNS is often referred to as the "fight or flight" mode.
PNS activation is well known to have an inhibitory influence on the SNS, heart rate, respiration
and the viscera, and it has been widely regarded as the "rest and digest mode". More recently,
polyvagal theory has superseded previous views suggesting that the SNS directs all increases
in the ANS response (Porges, 1995, 2001, 2003a, 2004), and that the SNS and PNS systems
are engaged in a bipolar-type balancing function. Rather, it has been neuroscientifically
established that there is a hierarchy of responses based on the evolution of the nervous system
(Porges, 2004).

Polyvagal Theory
Polyvagal theory proposes a more dynamic understanding of ANS arousal modulation
patterns, focusing on its hierarchical, phylogenetic organization and response patterns as
being influenced largely by the PNS branches (Porges, 1995). In fact, three hierarchically
organized ANS subsystems influence heart rate, levels of alertness, the ability to functionally
communicate and relate to others, and the ability to respond to perceived threats (Porges,
2004). According to polyvagal theory, the phylogenetically newest and myelinated PNS
branch (ventral vagal PNS) responds first. If that response is not sufficient for the experience
at hand, the next system (in phylogenetic order) responds, which is the SNS, followed by
the oldest and most primitive, unmyelinated PNS branch (dorsal vagal PNS) (Porges, 2001,
2003a). Table 3 provides further information on the PNS branches.
Table 3: Parasympathetic Nervous System Branches

Parasympathetic Structure Primary Body Parts
l Functional
1
Nervous System Influenced Influence Examples
(PNS) Branches
Ventral • Myelinated branch • Inhibitory input • Social engagement
Parasympathetic of the vagus nerve to the viscera, and affiliation
Branch of the Vagal including heart rate
Nerve • Originates in the • Levels of
nucleus ambiguous • Influences the consciousness and
Phylogenetically of the brainstem following muscles: alertness
newest; most • eyelid
sophisticated; only • Facilitates
found in mammals • facial occupational
• middle ear performance and
• mastication participation
• laryngeal
• pharyngeal
• head turning,
head tilting
_, __
Dorsal • Unmyelinated • Inhibitory input to • Main function:
Parasympathetic branch of the vagus the viscera: Survival
Branch of the Vagal nerve • heart rate
Nerve • Protection
• Originates in the • respiration rate
Phylogenetically older; dorsal motor • Energy
most primitive nucleus of the conservation
brainstem • Immobilization
In addition to many other variables, the degree and duration of the threat impacts ANS
arousal modulation patterns, as well as the overall complexity or flexibility of the dynamic
human system, in the moment and over time. For example, when talking to a co-worker
about an incident you were involved in at work, you might begin the conversation in a
relatively relaxed manner, with your ventral vagal PNS leading the modulation pattern of
ANS response. If you begin to feel as though you are being wrongfully accused of not doing
your job effectively, this might (in some cases) be enough to trigger the SNS response (the
next in the phylogenetic order of evolution).
I Philosophy. Science and Occupational Therapy 15

Siegel (1999) proposed the "window of tolerance" metaphor, representing the degree of
complexity of the range within which individuals can modulate the PNS and SNS systems,
before the next hierarchical level is triggered (ventral vagal PNS before the SNS , followed by
the dorsal vagal PNS response). Porges explains that the ability to communicate functionally
is strongly correlated to having the neurological support to do so (Porges, 2003a, 2003b,
2005). From the level of the ANS, the ventral vagal PNS provides the support necessary to
communicate in a manner that is generally calm, organized and flexible, however, when
a person feels in danger, the ventral vagal system is often overridden by the SNS or dorsal
vagal PNS. For example, people with complex trauma histories, may have difficulty engaging
the ventral vagal PNS, due to an ongoing sense of impending danger or other ongoing
trauma symptoms. This is also often true for people with symptoms of mental illness and
sensory processing issues. Refer to page 56 for a visual representation of how these variables
are often related.
Referring back to the previous example, the more flexible and cohesive your system is, the
better control you will have over not allowing your co-worker to trigger you, and the more
resilience you will have in terms of your ability to "bounce back" in the event that you do
become triggered (wider window of tolerance). In some cases, however, confrontational
experiences in and of themselves may be enough to trigger the SNS or the third hierarchical
and most primitive level (dorsal vagal response). Furthermore, it is evident that for people
with trauma histories, the "window of tolerance" tends to be less flexible and their arousal
level may become rigidly fixed, or become disorganized and extremely turbulent or unstable
(e.g., instability patterns) (Siegel, 1999; Ogden et al., 2006). In addition, imagine the impact
of cognitive disabilities or sensory processing on one's "window of tolerance" in addition
to other symptoms, and contextual and environmental variables. Within dynamic human
systems, all of the aforementioned variables are interrelated and interdependent.
While there are many variables that coexist and contribute to a person's ANS arousal
modulation responses, such as other mental health symptoms and sensory processin g
patterns, it is important to be aware of the current neuroscientific advances emphasizing the
complexity of human systems. This information helps to explain some of the structures and
functions of the nervous system that contribute to our understanding of sensory processing,
and the impact of mental health symptoms, stress and trauma experiences on the ability to
participate in meaningful life activities and the recovery process.
When chronic stress, trauma, or mental health or sensory processing issues occur, the "window
of tolerance" is often narrowed (Siegel, 1999). When this is the case, the ventral vagal system is
often not the primary branch leading "the dance", as the other subsystems may take precedence.
Individuals often demonstrate behaviors, or fluctuations of behaviors, that indicate they are
in one ANS response pattern or another. Consequently; signs of a chronic SNS or dorsal vagal
PNS response pattern, or disorganization, multiplicity or a significant fluctuation in response
patterns may also reveal that this has become the more persistent pattern. Being outside of a
more flexible ANS response pattern range for long periods of time can have severe implications
for overall health and wellness, and may become the dominating pattern.
Generally, when people of any age feel safe and secure, the ventral vagal system leads the
dynamic "dance" of the ANS subsystems, maintaining or expanding the "window of tolerance".
Feelings of safety help to facilitate the ventral vagal response and support a more optimal
range of arousal, further supporting communication and attunement capacities. Thus, it is
essential when working with people with trauma histories, mental health symptoms, and
sensory processing issues across the lifespan, to provide interventions that facilitate the
co-creation of "safe space". The intervention ideas reviewed throughout this book provide

an array of resources to help co-create feelings of safety, security and stability for clients,
staff and caregivers. This is the first step in building a therapeutic alliance and in helping
clients to realize that they have the power to change the way they feel. It is also necessary
for developing healthy relationships. The sensory modulation program offers resources
that help to operationalize the ability to provide interventions that are empowering and
facilitate feelings of safety, security and containment. This is the first step in helping clients
work toward the ultimate goal of increasing their functional performance and occupational
participation. In addition, the sensory modulation program advocates for the individualized
use of these interventions not only for stabilization-related goals, but also for prevention,
health and wellness goals.
Attachment
Having a flexible, resilient nervous system supports the ability to engage socially and
functionally in meaningful daily life roles and activities, and to cope with general life
stressors. Ayres (1972, 1979) and Kinninburgh, Blaustein, Spinnazola and van der Kolk
(2005) have developed theoretical and visual models representing the dynamic interplay
between attachment formation and sensory integration in infancy and childhood, and the
development of the ability to self-regulate (e.g., affect and sensory modulation) and attain
competence in higher-level skills (e.g., executive functions). Both demonstrate how sensory
integration and affect regulation impact higher-level skills.
According to many of the authors on attachment, one of the cornerstones to having a
flexible, resilient nervous system is having strong attachments in infancy and childhood
(Bowlby, 1988; Shore, 2008a). Evidence-based literature on the effects of trauma supports
the view that having prolonged, chronic stress or trauma experiences, and being over
exposed to environmental toxins, contribute to structural changes and decreased flexibility
in the developing nervous system. These variables often negatively influence the adult
nervous system as well, yet when encountered in childhood one's entire sense of self and
neurophysiological and relational systems are developing, and so pervasive effects often
emerge (e.g., sensory processing disorders, learning disabilities, defensive patterns) (Felitti,
Anda, Nordenburg, Williamson, Spitz, Edwards, et al., 1998; van der Kolk, 2005, 2006).
According to Shore (2003a), "if attachment is the regulation of interactive synchrony, stress
is defined as the asynchrony in an interactional sequence, and, following this, a period
of reestablished synchrony allows for stress recovery and coping" (p. 242). Shore (2003a)
further asserts that the fundamental building blocks of attachment security include affect
synchrony and resiliency.
Ayres (1964, 1972, 1979) initiated, created and promoted sensory integration theory,
evidence-based assessment tools, and an array of interventions to help facilitate adaptive,
integrative responses in order to support development, affect regulation, resiliency and
occupational participation (e.g., self-care, rest/sleep, education, play, leisure, and social
participation). Her work has been expanded upon over time and continues to grow in its
application. Many of the approaches outlined in this book have been taken from or inspired
by her work, and the works of others, in order to help individuals with attachment disorders,
trauma histories, mental health symptoms and sensory processing issues reclaim their lives
through the recovery process. In addition, Ayres' sensory integration theory, assessments and
interventions are being used by skilled occupational therapists specifically to target trauma
and attachment issues with children and caregivers. Modifications to Ayres' framework and
tools are also being used to collaborate with other disciplines to target attachment and
trauma-related issues impacting meaningful roles, occupational participation and recovery.

Sensory Modulation and the Stress Response
Stress is an individual experience that is believed to have the ability both to harm and/or to
help. Prolonged or chronic stress has been proven to produce illness or exacerbate existing
illness. We are not at the mercy of the negative consequences of prolonged or chronic stress,
however, and many researchers have developed ways to combat the unhealthy influences of
the stress response. For instance, Herbert Benson developed and researched what he refers
to as the relaxation response (Benson, 2000). His first book on the subject, published in the
1970s, promoted the notion that meditation has a relaxing influence. Benson is one of many
professionals who have promoted the mind-body connection and the use of relaxation
techniques to decrease stress and promote health. Deepak Chopra (1993) is another leader
in the mission to scientifically establish meditation and other interventions as positively
influencing health and feelings of well-being. Jon Kabat-Zinn (2005) is well known for his
work in promoting the use of mindfulness. Currently, the literature suggests that some of the
most common techniques or exercises used to decrease the stress response include:
• Deep breathing
• Mindfulness
• Meditation
• Body scan
• Progressive relaxation
• Guided imagery
• Relaxation tapes
• Exercise/yoga
• Distraction activities
• Moving to a less stimulating environment
In occupational therapy, it is recognized that relaxation techniques may not be the only
interventions to focus on when working with people who are experiencing stress due to
occupational crisis. It is also recognized that, at times, people may not have the ability
to utilize some of the methods listed previously, for a number of reasons. Occupational
therapists collaboratively assist in the assessment of the kinds of interventions that may be
helpful and the degree and type of support necessary for successful use. The spirit-mind
body-world interconnection is also well understood; thus, the ability to use the body to
influence the mind-and the mind to influence the body-is recognized and capitalized
on to positively influence the spirit (Champagne, et al., 2007).
Sensory modulation interventions also differ from standard stress reduction (relaxation)
exercises, in that the need for a range of individualized options is well understood. These
options range from those that are considered to be relaxing to the individual, to those that
are alerting in nature-or some combination (Champagne, 2003a; Champagne & Stromberg,
2004). For example, Tschacher's (1995) work with people with depression demonstrates
that many people with depression (without the anxiety component) do not find relaxation
techniques helpful. In fact, relaxation techniques used with this population actually had
a negative influence. Mullen, Champagne, Krishnamurty, Dickson and Gao's (2008) study
on the use of the 30-pound (approximately 14 kilograms) weighted blanket with an adult
population also demonstrates that what is considered relaxing and helpful to one person
may have the opposite effect for another. Again, these studies support the body of work
on the mind-body connection, but also demonstrate the complexity of dynamic human
systems, human system responses and the need for individualized approaches.

The survival and quality of life of a living organism are dependent upon many variables. One
such variable is the ability to self-regulate, which is directly related to and dependent on the
process of sensory processing. In fact, at one time the term "self-regulation" was synonymous
with "homeostasis". Scholars in Ayres' Sensory lntegration8 have largely focused on the
neurological activity at the brainstem level, due to its role in the self-regulation of arousal
levels and homeostasis. However, we now know that sensory processing is far more complex
than originally thought, and our traditional understanding of the process of homeostasis
itself is in question.
Homeodynamics
A greater understanding of the complexity of homeostasis, and the advent of new methods
of exploring nonlinear dynamics, have made it possible to take a more dynamic approach
to exploring the concept. The term "static", or "stasis", refers to a system that is not moving
or changing; one that is fixed in space and time. Linear systems are able to reflect such a
state. Human systems are nonlinear and always changing, and therefore, "dynamic" is a
more fitting term to accurately reflect the dynamic and complex nature of human systems.
Miller (2003) proposed the term "homeodynamics" as a more accurate way to promote and
comprehend the process of homeostasis and the host of possibilities of the spirit-mind-body
world relationship among dynamic systems. He promotes the view that homeodynamics
requires a "continual reformulation of part-to-whole relationships in an open system that
is always responsive in one way or another to the continual changes in input from both
internal and external stimuli" (p. 57). It is important to point out that Miller is speaking here
with the understanding that internal and external stimuli are not separate entities, further
substantiating the homeodynamic viewpoint. Miller further elaborates: "continually responsive
feedback among an organism's parts results in changes that are simultaneously physical and
psychological .. . governed by consciousness" (p. 58). He also refers to the primitive nature of
homeodynamics as instinctual, in that the system is able to coordinate the flow of energies
and biological mechanisms without the need for conscious awareness. Ultimately, in this view,
the spiritual, emotional, mental and biological components are all intimately involved in the
entire process and cannot be considered as being in any way separate.
Although the human system initially receives information from the world as sensory
stimulation or input via a relatively linear process, that information is dynamically processed
and perceived by means of a very nonlinear process (e.g., multiple feedback loops). While
Canon was referring primarily to the involuntary nervous system responses when talking of
psycho physiological responses, we now know that a plethora of factors influence how people
perceive and respond to stress. Further, it is well recognized that, in some cases, people
create (consciously or unconsciously) their own stress. Additionally, repression of stress
can lead to severe mental, emotional, physical and spiritual symptoms {e.g., occupational
deprivation). Miller (2003) further states: "when effective homeodynamic interactions of
a system are frustrated or diminished beyond an acceptable range they provide warning
signals involving sickness and dysfunction" (p. 61). Hence, it is often the goal of therapy
to help the individual recognize the source of their stress and in doing so help them move
toward a more dynamic state of health, rather than illness. Thus, decreased fragmentation,
and ultimately the increased flexibility and restoration of the coordination between the
spirit-mind-body-world, affords the ability to experience the universal flow state necessary
for feelings of coherence and well-being.

Champagne, Ryan, Saccomando and Lazzarini (2007) demonstrate a nonlinear approach
to occupational therapy practice applying the IMP model, and emphasizing the value
and necessity of recognizing the spirit-mind-body-world interconnectedness and
interdependence, through a case study (see Figure 3). This further validates the importance
of a nonlinear dynamic view, and emphasizes the importance of engaging in comprehensive
therapeutic interactions in order to better assist individuals in the recovery process.
Figure 3: Spirit-Mind-Body-World
Champagne, Ryan, Saccomando & Lazzarini (2007). Reprinted with permission.
It is also necessary to point out that in chaos theory it is understood that movements
between order and chaos are fundamental to living systems, growth and the change process.
In complexity theory, order and chaos are also said to coexist, like yin and yang, as opposites
along an energetic continuum. Additionally, in complexity science, the phrase "complex
adaptive systems" is used to describe living systems, such as human beings, and to explore
the complex nature of system change. Nonlinear scientific approaches must be used to
further support the validation of the spirit-mind-body-world interconnectedness and
interdependence, which could have monumental effects on the way society views therapeutic
systems of care, therapeutic interventions and the human system change process.
Human System Adaptation: The Process of Learning

It often takes time for the system to relax after perturbation, due to the deviation away from
stable attractor states, also referred to as a critical slowing (Kelso, 1999). It is important to
understand that, although a pattern may be initially perturbed, the basin of attraction may
still present unless bifurcation occurs. Thus, following perturbation, the attraction toward
the basin may not be fully lost. This is often seen in the process of relapse, or when trying to
learn a new way of doing something after doing it the same way for years. This explains why
the only way to change a deep attractor (or habit) is through bifurcation (destabilization) of
its basin of attraction. The process of new learning, from a nonlinear dynamics perspective,
is that of a bifurcation influencing a change in the spatiotemporal patterns of an entire
attractor layout (Kelso, 1999). Thus, a bifurcation occurs when the system reaches a critical
point, leading to a qualitative change in an entire attractor layout (Kelso, 1999). Such a
dynamic change is also referred to as a non-equilibrium phase transition (Freeman, 2000a;
2000b; Kelso, 1999).
A nonlinear dynamics perspective views stress and illness as a different way of functioning
by the same individual. The phase transition to a paranoid and psychotic state from a
more functional coordinated dynamic state demonstrates how psychiatric phenomena may

manifest. The same can be said when one shifts from a stressed to a more relaxed dynamic
state. Chronic stress responses may be viewed as a habit requiring bifurcation to ensure a
change in habitual attractors, evident in changes in lifestyle and behavior. Perturbation and
bifurcation are dynamic and emergent processes necessary for learning, unlearning, growth
and change. These are mechanisms therapists use to attempt to influence change. Such
mechanisms are most often useful when therapeutic exchanges are in some way meaningful
to the individual.
Chaos and complexity theories have been used to explore system adaptation from the
standpoint of human resiliency. Kobasa and her colleagues chose to study "hardiness" and
included people who were ill and those who were healthy, searching for key personality
variables distinguishing the two groups. This work also promoted the importance of de
emphasizing the sole focus on pathology. The three key variables related to hardiness have
been identified as challenge, commitment and control (Kobasa, Maddi & Courington, 1981).
To elaborate, these variables include: the ability to perceive the ongoing changes in life as
challenges as opposed to threats (challenge); the ability to stick to a vision, goal or plan
despite increasing environmental complexity {commitment); and feeling at least in partial
control of the events occurring (control).
Embodied Experiences: Here and Now

Dynamic Landscapes of Experience
So, what might a more nonlinear approach to the study of psychophysiology be like,
particularly in regards to the spirit-mind-body-world arguments, and works related to stress
management and homeostasis? Minimally, it would need to include nonlinear science.
According to Francis (1998), "in spite of a shifting paradigm in health from a fiercely biomedical
model to a biopsychosocial model, the linear models of equilibrium still hold" (p. 157). It is
well established that human systems are far-from-equilibrium systems. Classical scientific
approaches are based on working with equilibrium systems. Human beings, however, are
dynamic landscapes of experience. Our histories contribute to who we are today, and our
ongoing and future experiences help to shape who we shall become. Human beings change
in response to continuously stretching forth and hypothesis testing through embodied
experiences. The spirit-mind-body-world interdependence and interconnectedness is deeply
established in nonlinear works, particularly those related to embodiment. Since it carries
many definitions, full embodiment, as used by this writer, is perhaps best described by the
following quotes. According to Rafael Nunez (1999):
It has a commitment to all of cognition: from the most basic perceptive activity
to the most sophisticated form of poetry and abstract thinking. Full embodiment
explicitly develops a paradigm to explain the objects created by the human mind
themselves (i.e., concepts, ideas, explanations, forms of logi,c, theories) in terms of
the non-arbitrary bodily experiences sustained by the peculiarities of brains and
bodies. An important feature of this view is that the very objects created by human
conceptual structures and understanding (including scientific understanding)
are not seen as existing in an absolute transcendental realm, but as being brought
forth through specific human bodily grounded processes. Conceptual experiences
and forms of understanding are not considered a priori, but they become subject
matters to be explained in real-time and bodily grounded terms. (p. 56)

Further, the interconnectedness and interdependence of the spirit-mind-body-world are
fundamental and essential within this view of embodiment. And all human experiences are
considered embodied experiences, since it is impossible to take an individual out of his or
her context and time. According to Esther Thelen (2003):
... to say that cogn.ition is embodied means that it arises from bodily interactions
with the world and is continually meshed with them. From this point of view,
therefore, cognition depends upon the kinds ofexperiences that come from having
a body with particular perceptual and motor capabilities that are inseparably
linked and that together form the matrix within which reasoning, memory,
emotion, langua.ge, and all other aspects of mental life are embedded. (p. 18)
By fundamentally establishing spirit-mind-body-world as a given, other topics such as the
stress response may be viewed from a nonlinear perspective as a habitual attractor, organized
across multiple scales (Francis, 1998). One way of viewing stress or illness when using a
nonlinear approach and the concepts reviewed in this chapter includes (but is not limited to)
the following example. When stress or illness becomes an attractor pattern, it becomes the
tendency of the entire system to respond in a particular way, with the slope of the attractor
related to the stability of the attractor pattern (Francis, 1998). What does such a view mean,
and how does it influence occupational therapy practice? Deeper conceptualizations, and
applications of phenomena such as homeodynamics and embodiment to OT practice, will
assist in the evolution of a more dynamic view of human occupation and OT practice. The
concept of sensory processing, for example, will also be validated as a multidimensional
variable, essential to human occupation, as a more dynamic view of occupational complexity
emerges. The same would be true for all occupational performance skills that support
occupational performance patterns and the recovery process.
Summary
The next decade promises an explosion in the advancements of science and mathematics.
Likewise, these advancements hold promise for new models and research methods capable
of more deeply capturing the dynamics of the process of self-organization and positive
change in dynamic human systems. This will have a significant impact on all healthcare
professions, occupational therapy included. Thus, it is an exciting time as we move closer
to the development of models and research methods that will ultimately provide the ability
to capture the deep essence of human dynamics and emergent change processes. Nonlinear
approaches will not only help to demonstrate the complexity and dynamics of change; they
may also help to substantiate the essence of occupational therapy and its interrelatedness
and interconnectedness with occupational science, which is necessary to demonstrate its
authenticity. In this way, we may be able to fully validate the nonlinearity of the profession
and its deeply authentic, historical roots.
"You cannot solve a problem with the same consciousness that created it."
-Albert Einstein

Evaluation
and Dynamic
Systems
Exploring Dynamic System Tendencies
Occupational patterns are unique and influenced by one's spirit-mind-body-world
experiences across the lifespan. These patterns include the dynamic system tendencies that
may aid and/ or interfere with the ability to engage in meaningful activities in a functional
manner. In addition to an individual's strengths, there may be occupational patterns that
contribute to crisis-related feelings and responses, often referred to as occupational crises.
The initial evaluation process is a collaborative and exploratory one. The use of chart review,
interview, observation, and formal and standardized assessment tools is just the beginning
of this process. Every therapeutic exchange is essentially a continuous evaluation of what is
meaningful to the person, how they engage in their roles, routine and activities, the kinds of
activities they may seek or avoid, and why, and whether they are ready and willing to engage
in the therapeutic process.
As occupational therapists, we must ask ourselves the following questions:
• Do our evaluation processes really support our attempts to understand the dynamic
patterns of human behavior?
• Do our collaborative therapeutic exchanges afford experiential opportunities that help to
identify and discover ways in which to shape patterns of behavior (habits)?
• How do the services we provide help to facilitate and support the processes of self-
organization and self-actualization?
• Are we helping to co-create an environment where people feel a sense of safety and security?
When evaluating dynamic systems it is important to consider the part(s), the whole, and
the greater whole in context and time. An individual's dynamic history, patterns, degrees
of freedom (flexibility), tendencies and preferences are some of the areas that must be
carefully explored prior to making assumptions about the dynamics of human behavior.
Although we can never know everything about a dynamic human system, it is important to
get a sense of the complexity of human systems and to engage in therapeutic processes that
better enable the ability to explore the dynamics of human behavior. Further, how a given
pattern persists under various environmental conditions {its stability), and how it adjusts to
changing internal and external conditions {its adaptability), must be accounted for (Kelso,
1999). The ability to assess the degree of stability and adaptability of dynamic human
systems in context and over time is one of the primary contributions of the occupational
therapy process (e.g., occupational analysis).
Nonlinear Applications to the Assessment Process

Assessment is part of the OT process and may be performed formally or informally. The initial
evaluation process is typically more comprehensive and lengthy, enabling the identification
of an individual's history and a baseline from which to measure future progress. Screenings
tend to be shorter in length, and are usually fairly easy to administer. Discriminative tools
help in identifying or classifying human system tendencies or patterns.
With the nonlinear dynamic approach, it is necessary for the individual to be central to
all aspects of the assessment process. According to nonlinear science, the following are
examples of some of the suggested aspects of the assessment process (Lazzarini et al. 2007):
1. Identify the system to be observed and the scale of observation.
2. Identify the attractor pattern (or lack thereof). Is there:
II Evaluation and Dynamic Systems 25

• A particular pattern evident?
• The absence of a pattern?
• Vacillation between patterns?
3. Facilitate a perturbance of the pattern at the point of instability.
1\vo common ways of viewing attractor instability are:
• Facilitating a perturbance and identifying how long it takes for the system to bounce back
• Identifying and manipulating the control parameter
A variety of tools or activities may be used in the steps outlined above. Again, the individual
must be central to the assessment process. Order parameters are "close to instability points"
and refer to the variables "governing the behavior of the system" due to the cooperative activity
of the parts of the system (Haken, 2003, p. 5). "Naturally occurring environmental conditions
or intrinsic, endogenous factors may qualify as control parameters" (Kelso, 2003, p. 50).
The nonlinear dynamic approach to evaluation is demonstrated in the occupational
therapy evaluation, assessment and reassessment processes. For example, when using
an Ayres Sensory Integration® frame of reference, the occupational therapist performs a
comprehensive initial OT evaluation, which includes the assessment of sensory processing
patterns when warranted. One example of an attractor pattern, which may be identified
as a barrier impacting occupational performance, is poor proprioceptive and tactile
discrimination, contributing to difficulty in completing self-care activities. It is important
to note that this is just one example of one attractor pattern out of the many possibilities
that are assessed as part of the OT evaluation and reassessment processes. This example,
however, demonstrates how occupational therapists employ the aforementioned steps as
part of the initial evaluation process:
1. Perform an initial evaluation and assessment process, which includes occupational
analysis (e.g., client-caregiver-activity-contextual-environmental factors).
2. Identify attractor patterns in the areas of sensory processing and occupational
performance (e.g., strengths and limitations).
3. The therapist facilitates a perturbance of the pattern at the point of instability to
identify when and where the problem reveals itself and the problem severity {e.g., use
of the Sensory Integration and Praxis Tests {SIPT), a Sensory Processing Measure, and
observational assessments to identify challenges in the pattern areas explored).
It is important to note that the processes outlined above are also used when challenging
individuals as part of the therapeutic intervention process, such as when trying to facilitate
an adaptive response (e.g., sensory processing pattern, readiness for change/motivation,
increased occupational performance).
Facilitating Change
We can learn a great deal from consumers if we choose to listen actively and to engage with
them in co-creating assessment processes, treatment plans, and therapeutic environments
that afford diverse, meaningful and sensory-rich therapeutic opportunities (Champagne,
2005; Hasselkus, 2002). The use of an initial interview, as well as formal and informal
approaches and techniques, may help to obtain a more comprehensive initial evaluation.
In addition to the host of performance areas explored during the initial evaluation, it is
important to (minimally) explore some of the questions listed below when helping consumers

to problem solve and determine what is in need of change. It may be necessary to rephrase
or adapt the questions so that they are specific to the person's ability level and situation. The
art of the evaluation process lies in the occupational therapist's ability to obtain information
by a host of creative means, and to help people understand what is being asked and how it
relates to them specifically-that is, what is meaningful to them.
• Have you recognized any patterns that interfere with your ability to function?
• How do these patterns affect your life?
• How do these patterns affect your roles and/or your daily routine?
• What do you want to change?
• Why do you want to make this change at this time?
• Do you feel like you are ready to make this change?
• What seems to trigger these patterns?
Readiness for Change

One of the purposes of sensory modulation interventions is to provide therapeutic
opportunities that are preparatory in nature. In this way, individualized sensory modulation
interventions assist the individual in feeling more ready and able to participate in meaningful
life activities (e.g., self-care, group sessions, school, work). Helping people to become more
able to participate in activities can also have a positive impact on readiness to change. Thus,
identification of the individual's ability level, supports needed, sensory processing patterns,
occupational goals, motivators and readiness for change is part of the evaluation process
and helps to co-create meaningful goals and the treatment plan.
Further, Prochaska, Norcross and DiClemente (1994) developed the Stages of Change, a
trans-theoretical approach to facilitating readiness for change and the change process. Part
of the OT evaluation process includes exploring and facilitating one's readiness to change.
Prochaska et al. (1994) promote the importance of helping individuals determine their
readiness to change, and encourage the use of specific therapeutic techniques considered
essential to influencing change. It is important to point out that, from a nonlinear perspective,
the change process does not always follow an identified specific order or stages. Rather, the
stages and identified strategies are intended to serve only as a guide. Also, in nonlinear
dynamics, change is seen in terms of phase transitions, rather than stages. Chapter III
provides more information on the stages of change, which is often useful in both the
evaluation and treatment processes.
The Container Difference Exchange (COE) Model

Eoyang's COE model is a framework inspired by complexity science (Olson & Eoyang, 2001).
The CDE model is used to help evaluators determine how to most significantly influence the
shape, power and patterns that emerge as systems change over time. These variables must
not be considered reductionistically, given the complex and dynamic nature of the human
system change process. This is often evident when a shift in one or more variables (e.g.,
providing cues or environmental modifications) leads to system changes that can influence
seemingly simple, though drastic, outcomes (Eoyang, 1997).
The CDE metaphor is described as three complex conditions, or meta-variables:
• C = The container represents the boundaries of the dynamic system. It represents those
parts of the self that are self-organizing and may be physical and/or conceptual in nature.

There may be more than one given container, and conceptual containers are sometimes
difficult to recognize.
• D = The significant differences are those differences or tensions within the dynamic
system that most significantly contribute to the patterns of self-organization. Also referred
to as order parameters, these variables represent the potential for change.
,. E = The exchange is the transfer of energy, matter or information, which functions as an
exchange by linking the parts of the dyn amic system to the whole. Often referred to as
control parameters, these are the variables used to influence the formation of system-wide
patterns and, ultimately, self-organization.
To clarify, the transforming exchange itself refers to the dynamic process of self-organization
whereby the individual or client is the change agent. The therapeutic exchanges may be
viewed as the meaningful influences occurring during the therapeutic process (e.g., the
use of a "sensory diet", a mindfulness activity using a weighted blanket), and the therapist
is a facilitator of change. These exchanges occur in context and over time and may also be
referred to as dynamic feedback loop(s) between the control and order parameters.
The CDE model is just one example of how frameworks based on complexity science enable a
more comprehensive and dynamic approach to evaluating complex adaptive systems than past
linear {input-throughput-output) models. Looking at the part(s), the whole and the greater
whole requires the recognition of complex system patterns, tendencies and preferences within
context and time. Utilizing such an approach, we find ourselves asking deeper questions,
becoming more efficient at recognizing what is meaningful to the individual, the role of
relational dynamics, and ultimately becoming more effective in influencing readiness for
change. Evaluating complex human systems is an emergent, meaningful and active journey
that unfolds over time. The OT process is dynamic, and the use of nonlinear scientific
frameworks can help to scientifically demonstrate its richness.
Cognitive Evaluation
From a nonlinear scientific perspective, some of what is assessed by occupational therapists
includes the variability of dynamic human systems, the ability to coordinate both mind
and matter, and the sensitivity to initial conditions. These dynamic pattern variables,
observed in context and over time during occupational performance, provide an increased
understanding of the degrees of freedom (flexibility) of dynamic human systems. Allen and
Blue (1992) have long expressed the importance of recognizing a person's global abilities,
and of the need to adjust our expectations and provide adequate levels of support-or
the "best fit" -for people with cognitive limitations. Over the years, many therapists have
used a variety of cognitive assessment tools to help determine an individual's best ability to
function, appropriate levels of support and realistic treatment goals, within a given context
in time. Some of the cognitive models and tools used in occupational therapy, however, lack
a fundamental nonlinear scientific premise. As reviewed in Chapter I, it is necessary to use
scientific approaches that support the complexity and dynamic nature of the system(s) being
studied. The current application of dynamic systems theory (DST) in the fields of physics,
mathematics, neuroscience, rehabilitation and many others suggests a paradigm shift and
emphasis on applying DST within the physical and life sciences. It is a promising shift, which
will have a tremendous impact on all aspects of rehabilitation services and future research.
28 Sensory Modulation & Environment: EssenUaJ Elements of Occupation

Embodied Cognition: Occupational Authenticity
An important shift in our thinking, when adopting a nonlinear approach, is a deeper
understanding of what is meant by embodied cognition and the self-organized process of
emergence. We can no longer look at cognition in a vacuum; looking at one neuron or one area
of the brain in isolation. Cognitive, sensory and psychosocial processes are not completely
separate entities. Rather, they are inseparably linked in what might be more accurately referred
to as embodied cognition or occupation, as process. While linear methods have afforded much
information about the parts of dynamic human systems, fragmentation in our views has
occurred. The application of nonlinear approaches affords the ability to look at the dynamic
relational processes and emergent patterns (occupation as process and performance) as a
dynamic web of experience. While at first this paradigm shift to the inclusion of nonlinear
approaches may appear to the novice reader to be merely a change in vocabulary, it is in fact
a deeply profound change in the way we view, discuss and explore human occupation.
The entire dynamic human system works together in context and real-time. A nonlinear
dynamic systems approach recognizes the microscopic, mesoscopic and macroscopic levels of
organization, and no one area or scale is more or less fundamental than any other to behavior
or self-organization. Instead, these processes emerge from dynamically heterogeneous
interactions, and from the process of competition and coordination across all levels of
organization.
The following are properties of coupling, which are essential to optimal performance:
• Multifunctionality
• Transient stability
• The ability to flexibly change and adapt according to internal and external environmental
demands
Coupling, or habitual coordinated processes and actions, leads to what is observed as
probabilities of human behavior, but never predictions. The complexity of human behavior
can never be fully predicted. The probabilities of human behavior, are sensitive to contextual
and environmental influences-past and current experiences. Again, this differs from linear
scientific approaches, which are firmly based on a belief in the ability to predict what a
dynamic human system will do. To explore cognition from a nonlinear perspective requires
the ability to measure the fitness of human patterns of behavior in context and time, with the
understanding that probabilities are more accurately viewed as "forecasts" of human system
behavior. Thus, the fitness (flexibility/ complexity) of the system refers to the variability and
coordination of mind, matter and information in context and time.
Cognition and meaning emerge through repeated, dynamic cycles of action-perception
assimilation {Freeman, 2000a). Research completed by Thelen (2003} and Thelen and Smith
(2000) has shown that the processes that build stable and active movement are the same
processes that build stable and adaptive cognition. It is the global cooperation and flexibility
(complexity) of the system that primarily influences one's best ability to function within the
ever-changing environment.
The amount and rate of information flow from the environment can be extremely
overwhelming to people with cognitive, sensory processing and psychosocial limitations.
Reduced fitness (complexity/flexibility) of a person's system may make it more difficult
for them to interact within their environment. Occupational therapists have noticed that
as the flexibility of the system decreases, the ability to tolerate and respond to the rate

of information flow within a given context in time changes considerably, and the ability
to perform purposeful activities effectively and safely lessens. This is often evident, for
example, in acute-care mental heath and long-term care settings when an individual may
be unable to tolerate the degree of stimulation in the therapeutic milieu and may prefer a
lower-complexity (lower-stimulation} environment until he or she feels less overwhelmed.
Dynamic Cognitive Level Considerations

The following information is an initial attempt at applying a nonlinear dynamic systems
approach to the Allen Cognitive Levels, a model created using the classical scientific methods
of cognitive science available at the time (input-throughput-output) (Allen, Earhart & Blue,
1992). Glenda Eoyang's CDE model was used in an initial brainstorming attempt to develop a
more dynamic approach to describing the Allen level scale. Using the COE model, Lazzarini
and Champagne created the following in 2003, which was subsequently revised by Champagne
for the 2008 edition of this publication. This is by no means a finalized product and it is not
endorsed by Claudia K. Allen or Allen Cognitive Advisors, Ltd. Rather, it demonstrates some
of the differences in an existing model when attempting to apply methods from complexity
science for the purposes of screening the cognitive fitness (flexibility) of the system. In this
view, the Allen levels constitute a complexity scale.
This listing is not all-inclusive or finalized. It is meant to serve as an initial introduction to
some of these concepts and terms as they are applied to the Allen Cognitive Levels. Depending
upon what is meaningful to the individual and his or her unique trajectory of life experiences,
variations from this guide may occur. The therapeutic exchanges are the therapeutic processes
occurring between the therapist and the consumer within the physical environment, while the
transforming exchanges are the processes of self-organization occurring within each individual
{the consumer as change agent). The modes are not explored. Each cognitive level may be
viewed as an individual's fitness landscape, represented as a trajectory of cognitive complexity.

The CDE Model and Allen Cognitive Levels
Level 0: Coma
Container: Boundaries or constraints of the system:
• Coma-a prolonged state of being unconscious
Difference: What changes:

• Stasis/ equilibrium/synchrony
• Entropy
Therapeutic exchanges:
• 24-hour total care
• Positioning and range of motion
• Sensory stimulation
• Palliative/comfort care
• Meaningfulexchanges
Fitness of the system:

• Total dependence on caregivers
• Life support
Level 0.8: Generalized Reflexive Actions

• Total body responses: flexion/ extension, change in respiration
• Startle reactions: open/ closing eyes, hands, mouth
• Changes in respiration
Difference:
• Limited energy exchanges with the physical environment: increasing entropy (stasis)
• Microscopic does not sustain macroscopic states
• Positioning and range of motion
• Sensory stimulation
• Palliative/comfort care
• Meaningfulexchanges

• Total dependence on caregivers
• Life support

Level 1 : General Responses to Stimuli
• Although conscious, there is very limited flexibility within the system; degrees of freedom
• Close to equilibrium
• Limited emergence
• Able to locate meaningful stimuli
Difference:
• Extremely limited exchange in the flow of information (e.g., communication)
• Demonstrates increasing tolerance for range of motion with assistance
• Meaningful stimuli often sustain limited actions
Considering the individual's threshold of consciousness:
• Positioning to limit contractures and prevent skin breakdown
• Providing appropriate forms of sensory and motor stimulation to elicit positive emotional/
behavioral responses
• Environmental modifications and considerations
• Palliative or hospice care: providing gentle, comforting and meaningful interactions

• Total dependence upon caregivers
• Begins to move in bed
• Awareness of external stimuli, particularly when meaningful
At this cognitive level, soothing environments with meaningful exchanges are often provided
to protect against overstimulation, while decreasing the possibility of sensory deprivation.
Level 2: Postural Actions

• Deep attractors remain and are based on basic habitual and deeply meaningful experiences
• Limited exchange of basic energy and information with physical environment (e.g.,
physical environment and people)
• Generally, may be attentive to: positioning/movement, own body, food, furniture, own
clothing, range of motion, and others when within the person's visual field
Difference:
• Lack of balance due to decreased proprioceptive, vestibular and tactile feedback (e.g.,
often demonstrates gravitational insecurity during transfers)
• Can overcome gravity, although often unsafe (e.g., rollover, sit, stand, walk)
• Orientation to self becomes more apparent

• Increased exchanges of energy within the physical environment (e.g., communication
increases, attempts to engage in actions with objects with inconsistency in ability and
coordination)
• Lack of safety awareness
• Providing 24-hour care and assistance for safety, comfort, companionship and meaningful
interactions
• Providing maximal assistance for all areas of care
• Providing support for gravitational insecurity (fear responses) during movement,
positioning and transfers
• Environmental modifications and considerations providing appropriate forms of sensory
stimulation to prevent sensory deprivation and/or overstimulation
• Providing a safe walking and exploratory environment

• Relationships: generally offer meaningful companionship and comfort care
• Generally attentive to: positioning, movement, own body, food, furniture and own clothing
when within the person's visual field
• Often demonstrates what appears to be sensory-seeking and/or avoidance patterns
• Begins to prefer upright positions and tries to overcome gravity: sits, stands, starts
"cruising", or walking with adequate levels of physical support and/or verbal scaffolding
• Maximal dependence upon caregivers
• Increased use of coordinated movements, although inconsistent
Individuals at this cognitive level (phase transition) are beginning to overcome gravity
through postural adjustments and gross motor movements. These individuals are generally at
high risk for falls and often become combative with care. Gravitational insecurity is common
at this cognitive level. Offering items to hold, providing assistance to assure the person's
feelings of security during all movements/transfers, and approaching the person from the
front (within his or her narrow visual field) often helps to reduce fear, and aggressive and
combative behaviors. Use of a slow pace is essential. The skilled therapeutic use of music,
aromatherapy, therapeutic touch and positioning techniques, and calm and concrete social
interactions are among the common recommendations within this cognitive level.
Level 3: Coordinated Patterns of Manual Actions

Container: Boundaries or comtraints of the system:
• Increased flexibility, energy and information exchanges
• Begins sustaining simple meaningful patterns of energy and information exchange within
the physical environment (evidenced by repetitive actions}
Difference:
• Increased awareness of energy exchange with physical environment; increased order
parameter
• Increased consistency in orientation to self and to meaningful people and objects (e.g.,
familiar caregivers, self-care items}

• As coordination (complexity) increases within the system, the person demonstrates
increased, coordinated patterns of manual actions
• 24-hour supervision is required
• Meaningful exchanges and therapeutic activities
• Providing caregiver education and enabling occupation by offering a sensory supportive
environment; scaffolding
• Generally attentive to: material objects and/or people within the person's visual field,
food, exterior surfaces of objects, exits
• Providing meaningful/familiar forms of stimulation: gadgets, pictures, pets, music, foods,
daily engagement in movement/ exercise and reminiscing
• Redundancy tends to increase a system's iteration at this cognitive level
• Environmental considerations: providing a consistent and safe environment and
decreasing the possibility of overstimulation and/or sensory deprivation. (Generally,
decreasing environmental variability and increasing reliability of informational exchange
facilitates order.)

• Desire to explore and manipulate items within the environment without a consistent
awareness of personal boundaries; ownership
• Sensory seeking with new and habitual actions
• Moderate dependence on caregivers; still requires 24-hour supervision for safety, health
management and self-care
• Often comforted when with family, friends and familiar caregivers; meaningful
relationships generally provide comfort, companionship and care
• Limited awareness of the greater physical environment
• Enjoys handling/manipulating objects
• Slow paced and will generally follow one-step cues
• Short attention span
• Engages in repetitive and sustained actions
• Orientation to self and is generally attentive to: material objects and/or people within
their visual field, food, exterior surfaces of objects, exits
At this level, the person is exploring their world predominantly through the use of touch,
vision, movement, and concrete (and often confused) social interactions. A calm, slow
paced, organized and structured environment is typically recommended. Manual repetitive
activities, such as sorting, wiping, painting, sanding and manipulating large-sized objects,
are often enjoyed within this cognitive level. Providing larger-sized objects for manipulation
will prevent the possibility of choking. Meaningful activities or conversations (regarding past
roles, tasks, music or activities) will often facilitate an increase in attention, interaction and
overall engagement. Structured and supervised sensorimotor tasks and group work become
appropriate forms of treatment within this cognitive level and often have very good results.

Level 4: Goal-directed Activities
• Increased system coordination {complexity) in all intentional activities
Difference:
• Increased awareness of temporal and spatial orientation
• Engages in activities versus actions on objects
• Limited or no awareness of/insight into illness, safety concerns or cognitive limitations
• Concrete and limited flow of informational exchanges
• Little to no awareness of future consequences of actions
• Not consistently aware of the "greater whole"
• Providing concrete and goal-directed activities
• Engaging in meaningful exchanges and therapeutic activities
• Using positive reinforcements {heavy social scaffolding)
• Providing environmental enhancements and modifications to facilitate self-organization
• Minimal caregiver assistance is required for general activities of daily living
• Moderate to minimal caregiver assistance is required for: medication and health
management, time management, money management, home management and
transportation
• Providing safety and prevention safeguards
• Providing caregiver education

• Oriented to person, place and the "here and now"
• Values social relationships
• The person's verbal abilities are often better than his or her safety awareness or ability to
perform novel tasks-hence, this may be misleading; may create issues related to safety
• Is often concerned about/values personal belongings and relationships; has the awareness
of ownership
• Values independence although requires daily supervision for safety, medication and
health management, home management, daily structure and social/leisure engagement
• May demonstrate difficulty recognizing the need for and/or accepting the level of
assistance needed (e.g., often needs assistance to follow through with goals)
• Often demonstrates difficulty in identifying and/or describing emotions
• Benefits from having an advocate; is vulnerable to abuse and/or being taken advantage of
At this cognitive level, the person's visual field of awareness broadens and becomes
increasingly more functional. An increase in the ability to consistently and functionally
scan the environment emerges. Thus, use of meaningful visual stimuli in the larger physical
environment becomes increasingly more useful during treatment sessions. For example, items
such as holiday decorations, posters, videos, 1V shows, mobiles or projectors easily capture
the person's attention and no longer require placement directly in front of them. Meaningful,
soothing and goal-directed forms of sensory stimulation and/or activities, and positive
reinforcement via interpersonal feedback, often result in successful treatment sessions.

Level 5: Independent Learning Activities
• Stress and emotional fluctuations may override cognitive abilities
• Has the ability to self-organize with increased informational exchange (e.g., environmental
pace)
• Rigid attractors (habits) due to loose or lack of flexibility of perceptual-action couplings
Difference:
• Greater longing for kinship and an increased ability and desire to engage in purposeful
exchanges with meaningful people and in meaningful roles and activities
• Providing social scaffolding to sustain performance until it becomes a learned (habitual)
experience {e.g., deep attractor)
• Providing clear and concrete social rules of engagement and ongoing reminders, as
needed
• The individual may need assistance with understanding why things need to be done in
specific and/or structured ways, and for follow through
• Providing meaningful choices for structured and supported occupations and heavy social
scaffolding
• Providing assistance with all independent activities of daily living
• Providing ongoing education regarding the purpose and importance of medication and
treatment compliance
• Providing education and reinforcing new skills regarding functional performance, health
and wellness, prevention, educational opportunities, social and coping skills

• Longing for kinship and intimate relationships
• Strong desire for meaningful roles: spouse, friend, worker, student
• Enjoys a broader range of choices regarding activity and role options, and generally
prefers to be self-directed with familiar or leisure tasks
• Difficulty in conceptualizing the "greater good", and may, therefore, be focused on "me",
"my rights", "it's not my fault"; may often feel victimized
• Benefits from having an advocate; is vulnerable to abuse and/or being taken advantage of
• Difficulty with effective time management and treatment follow through
• Difficulty with fast-paced and competitive work environments
• Benefits from weekly supervision
At this cognitive level the person becomes more independent with choices, tasks and
requests. The use of basic worksheets, checklists and daily planners (with assistance for
generalization, abstract reasoning, goal setting and follow through) is often a key element
for success. Assistance with medication/health, home, money and time management, and
increasing social skills/awareness is often meaningful and necessary. Therapeutic "homework
assignments" may require assistance for consistent and appropriate completion, and for
follow through.

Some examples of common sensory-based treatment ideas appropriate at this cognitive
level include: the facilitation of self-awareness through learning activities and self-reflection
regarding one's own systems tendencies, ability to self-regulate, potential triggers, creating
a meaningful "sensory diet", creating a safety/sensory kit, and other useful expressive/
integrative therapies.
Level 6: Planned Activities

• Flexible
• Highly coordinated neurodynamics {system-wide flexibility)
• Demonstrates the ability to engage consistently in competition and cooperation across a
host of meaningful and functional performance areas
• Attentive to: the "greater good", relational processes, symbolic and abstract cues, aspects of
time, hypothetical risks, anticipated hazards, social expectations, cultural considerations
and obligations
Difference:
• Significant complexity/coordination of neurodynamics
• Wellness, maintenance and prevention

• Independent in functional performance
• Complex adaptive system
• Values and contributes to the "greater good"
• Able to participate in roles/ meaningful occupations cooperatively and competitively
(flexibly)
This person has the cognitive ability to consistently plan, reason and follow through with
health and/or treatment recommendations. Training regarding the person's presenting
problem(s) and the scope of possible treatment options is typically valued. Helping to
facilitate awareness of one's unique systems tendencies and preferences, and of how these may
influence relationships and occupational performance, is beneficial. Providing discussions
about health, wellness, stress reduction and preventative techniques is often helpful.
Additional Considerations across the Levels

• What is meaningful, and why?
• How much assistance is needed for safety, occupational performance, and follow through
with meaningful goals?
• What sensory cues does the person attend to?
• Does the person have any physical or sensory impairments?
• Does the person have the ability to ignore irrelevant or noxious stimuli, when appropriate?
• What kind of reasoning is employed?
• Does the person demonstrate the ability to attend to and fully participate in meaningful
activities over time?

• What are the issues compelling the behavior(s)?
• Sensory-based considerations:
• At the lower levels, sensory stimulation is often used to assess and facilitate a
generalized response. Sensory modulation interventions enhance palliative and
comfort care interventions, which includes environmental modifications.
• At higher cognitive levels, sensory modulation interventions are used to assess and
facilitate an increased awareness of the person's unique systems tendencies and
preferences in order to help facilitate learning through the process of assimilation
and the ability to self-regulate.
Embodied Cognition Reconsidered

The Quest
The quest to develop a more dynamic and embodied model of cognition will require the
adaptation of prior frameworks and tools, or the creation of new frameworks and tools,
that not only consider cognition as it is described within much of the occupational therapy
literature today, but also capture more fully the sensorimotor and psychosocial elements as
variables that are not separate. The human brain not only filters sensory input (Freeman,
2000a; Haken, 1983; Kelso, 1999), but also actively seeks sensorimotor stimuli in order to
create perceptual patterns and meaning (Freeman, 1995; Haken, 2002; Kelso, 1999; Thelen &
Smith, 2000). Neural populations are self-shaped patterns that evolve as one stretches forth
in the world and learns from the sensory consequences of one's intentional actions (Freeman,
2000b). Occupational patterns, occupational performances and outcomes, however, do not
depend merely on sensorimotor stimuli or merely on cognition (Lazzarini, 2004). Instead,
the self-organization of one's actions in the world is the product of context, previous
experience, the states of arousal and attention, the expectancies of responding to stimuli,
the intentionality of individuals, and their goals and meanings (Freeman, 2000a; Lazzarini,
2004). It is the totality and the multidimensionality of our experiences that shapes who
we are and who we become. It is essential, therefore, to begin emphasizing how cognitive,
sensory processing and psychosocial processes are interrelated and interdependent, and
create embodied experiences.
Occupational Crises
Occupational crises are dynamic responses of the system and may be described as the
response of a system facing certain environmental perturbances (Lazzarini, 2004; Tschacher
& Brunner, 1992). There are many different types of crises and reasons for the occurrences
of crises. Variables that influence the emergence of occupational crises may arise from
within the person (feelings, thoughts) and/or from within the physical environment (hearing
an alarm or a person screaming). These triggers influence system-wide changes in one's
dynamic state, which includes emotion. Recognition of the complex, dynamic nature of
occupational crises is particularly necessary when engaging with persons experiencing acute
or distressing symptoms and/or situations. Thus, a more embodied approach to cognition,
and occupation (as process and product), is not exclusive to occupational therapists working
in mental health; rather, it is essential to all practitioners and practice settings.

Sensory Processing and Occupation
"The experience ofbeing human is embedded in the sensory events of our
everyday lives." - Winnie Dunn (Dunn, 2001)
Problems with sensory processing may occur across any one, or a combination, of sensory
systems, and people may or may not be aware of having such problem(s) or of how sensory
processing issues affect their lives. It is important to include the screening of sensory processing
related client factors and performance skills, in addition to other areas assessed, as part of
the OT process. Consequently, a more comprehensive approach to assessment will help in
identifying a person's occupational patterns, and assist in developing their ability to better cope
,,vith and/ or change those patterns when warranted. In this way, facilitating the identification
of functional and meaningful strategies in order to enhance a person's ability to engage in the
world in a more effective and comfortable way becomes a very meaningful and fundan1ental
part of the overall collaborative assessment and intervention planning processes. This belief
is evident in the work of Ayres (1979), who emphasized the influence of sensory processing
on cognition and psychosocial development, and ultimately on occupational performance
patterns and participation.
A New Taxonomy
A new taxonomy has been established regarding sensory processing disorders within the
field of occupational therapy (Miller & Lane, 2000; Miller, 2006; Miller et al., 2006). The aim
of the new taxonomy is to distinguish between the Ayres' Sensory Integration® framework,
sensory-related disorders and therapeutic interventions (Ayres, 1979). This movement is also
part of an attempt to develop a classification system for sensory-related disorders, which are
currently referred to as dysfunctions. "Sensory processing disorder" (SPD) is the umbrella
term used for the identification of sensory modulation disorders, sensory discrimination
disorders and sensory-based motor disorders (Miller & Lane, 2000) (see Figure 4).
Figure 4: Sensory Processing Disorder (SPD): An Umbrella Term
• Sensory Processing Disorder "
Sensory Modulation Sensory Discrimination Sensory-based Motor

Disorder Disorder Disorder
1 . Sensory modulation 2. Sensory discrimination 3. Sensory-based
• Over-responsivity motor coordination
• Under-responsivity • Postural disorders
• Sensory seeking/ • Dyspraxia
sensory avoiding
Miller & Lane (2000): Miller (2006); Miller et al. (2006).
"Sensations are nourishment for the nervous system." -A. JeanAyres (Ayres, 1979)

Table 4: A Comparison of Views: A Nonlinear Dynamic vs. Sensory Integration Theoretical
Approach to Sensory Modulation
Nonlinear Dynamic Approach to Sensory Sensory Integration Theoretical Frame

Modulation of Reference
Human systems are nonequilibrium systems Equilibrium assumption is fundamental to the

(Prigogine, 1994); homeodynamics (Miller, 2006) concept of homeostasis (Reeves, 2001)
Unpredictability focused (Gleick, 1987; Predictability focused (Parham, 1998)

Prigogine, 1994)
Sensory integration is part of the whole, Sensory integration is the foundation for the
necessary for the emergence of more complex emergence of more complex behaviors (Ayres,
behaviors; dynamic process of action 1974, 1979)
perception-action cycles through IMP (Freeman,
2000a, 2000b; Lazzarini, 2004)
Environmental relationship: includes internal and Environmental relationship: internal and external
external as interdependent and interconnected can influence each other (interactive) (Ayres,
1979; Miller, Reisman, McIntosh & Simon, 2001)
(Capra, 1996; Gleick, 1987)
Circular causality (Freeman, 1991, 1995, 2000a, Circular causality (Ayres, 1979)
1
2000b; Kelso, 1999) Spiral causality (Bundy, Lane & Murray, 2002)
Self-organization through active engagement Self-regulation/organization of sensations

leads to dynamic system change (human beings through active engagement leads to an adaptive
are dynamic systems) (Freeman, 1995, 2000a, response (Ayres, 1979)
2000b; Kelso, 1999)
Sensitive to initial conditions (Gleick, 1987; Sensitive to environmental influences

Lorenz, 1993) (Ayres, 1979)
Attractors, degrees of freedom and multi-stability Patterns of neurological and behavioral

processes (Ayres, 1979)
(Freeman, 2000a, 2000b; Gleick, 1987; Haken,
1983, 1984, 2003; Kelso, 1999)
,._.,,_, ___
, -- ""-·-· ,..,,_ -- - � -·- - - .. - - - __
.,,,,. ________
Phase shift/bifurcation requires destabilization of Sensory integration leads to targeted behavior/
old patterns and the creation of new patterns; skill (Ayres, 1979)
leads to system-wide change through learning Disorganization is often seen prior to system
and behavior change (Freeman, 2000a, 2000b; change/adaptation (Frick & Hacker, 2001)
Kelso, 1999)
One of the primary goals of therapy is increased One of the primary goals of therapy is
complexity (fitness/degrees of freedom) increasingly complex patterns of behavior
(Champagne et al., 2007; Lazzarini, 2004, 2005) (Ayres, 1979)
Occupation as emergent process: both means Mixed views in the SI literature on occupation
and ends (Champagne et al., 2007; Royeen, as means and/or ends; proposes that behaviors
2002; Lazzarini, 2004, 2005) are emergent
-····-·-·"' ,_.... ....
, ----

some cases, the kind of stimulation the person is hypersensitive to may even be considered
painful at times. Due to the dynamic nature of the human system behavioral response,
however, the corresponding behaviors observed may be in accordance with the underlying
sensory tendency (active attempts to avoid aversive stimulation), opposite (passive or does
not attempt to avoid aversive stimulation) or some combination (Dunn, 1999).
The following are examples of behavioral tendencies that may be evident with hypersensitivity
and an active behavior response:
• Outbursts
• Defensiveness
• Unusual habits
• Emotion disregulation
• Avoillance
• Isolation
• Rigidity
• Resistance to particular activities/sensations
• Hyper-vigilance
• Avoidance of queues (standing in lines) or crowds
• May self-injure
Individuals with hypersensitivity and a more passive behavior response are not as apparently
distressed, but are often irritated or bothered nonetheless. Patterns often seen with those
who are hypersensitive but passive in behavior response include the following:
• May demonstrate signs of depression, irritability, anxiety or fatigue
• May not avoid things they report as being bothersome
• May be ill often, due to prolonged exposure to stress-provoking stimulation/situations
• May or may not demonstrate difficulty in functioning
Sensory Under-responsivity (Hyposensitivity, or Low Registration)

According to Dunn (1999), hyposensitivity is also referred to as low registration, or sens01y
under-responsivity (SUR) (Miller & Lane, 2000) and corresponds to having a high neurological
threshold for stimulation. Having a high neurological threshold means that it takes a lot more
stimulation or stimulus intensity to become and/or maintain attentiveness or awareness.
Behaviorally, people with hyposensitivity may appear slow to respond or avoidant. Behaviors
may also be in opposition to what one might e:>...l)ect, however, and sensory-seeking patterns
may occur due to the need for increased stimulation in order to maintain a functional level of
alertness. The following are examples of behaviors that may be evident with hyp osensitivity:
• Appears inattentive or has difficulty paying attention
• Slow to respond
• May seem sluggish or lazy
• May appear hyperactive
• Emotion disregulation
• May be difficult to engage
• Tends to be easily distracted
• May have difficulty following directions
• May have difficulty sitting for periods of time

Human System Complexity and Sensory Modulation
While it is possible that an individual may have system-wide tendencies of either sensory over- or
Wlder-responsivity (hyper- or hyposensitivity), many people experience a combination of each to
varying degrees (Dunn, 1999; Miller, 2006). A person's dynamic system patterns and experiences
depend on many different variables. Genetic predispositions, the person's past experiences, the
different sensory system(s) involved, the task at hand, past traumatic experiences, and other
contextual and environmental factors are examples of some of the variables that may influence
a person's dynamic experiences and behaviors over time. Furthermore, a person may seem
generally defensive and averse to sensation in one specific area (as in tactile defensiveness), and
may not be able to tolerate being touched or having their hair brushed, yet may fully enjoy taking
care of a pet or wrapping up tightly in a blanket. Again, this emphasizes the need for thorough
assessment and a heightened understanding of the complexity of dynamic human systems.
Sensory Discrimination
"Sensory discrimination" refers to the ability to differentiate between the qualities of different
kinds of stimulation and gain awareness (e.g., temporal and spatial) (Ayres, 1972). Sensory
discrimination is essential to the ability to perform tasks and to feel comfortable in what at
times can be a very overwhelming world. Imagine being a young child and having difficulty
with temporal and spatial discrimination. Challenges such as climbing stairs, walking down
a sidewalk, catching a ball and riding a bicycle can be overwhelming and anxiety producing.
Problems with tactile discrimination can lead to difficulty recognizing the differences betvveen
qualities such as size, shape and textme. Imagine the potential impact of difficulty with sensory
discrimination on a person's ability to perform the following activities: buttoning clothing
or differentiating between objects without looking, tying shoes, washing dishes, cutting up
vegetables to make a salad, and driving. These examples demonstrate how sensory processing
is not totally separate from occupation when viewed as process and product.
Sensory Discrimination Disorder

This sensory processing classification category refers to when an individual has difficulty
,vith sensory discrimination and the resulting awareness that occurs through having this
ability over time. It may be related to, but is not the same as, having difficulty with sensory
modulation and sensory-based motor disorder. Thus, someone experiencing a problem with
sensory discrimination may demonstrate difficulties in other areas of sensory processing
and with functional performance, as evidenced by some of the following:
• Over-shooting or under-shooting movements (self-feeding, dressing)
• Delayed or slowed responses
• Fearfulness vvith changes in the physical environment
• Rigidity or difficulty V\rith changes in routine
• Difficulty identifying differences between different textures
• Difficulty with depth perception
• Difficulty knowing how much force to use when engaging in a task
• Difficulty understanding the concept of time
• Anxiety and panic responses
• Difficulty knowing what they are holding in their hand without looking at the object(s)
• Difficulty differentiating between tastes, smells or textures

• May speak loudly
• May have difficulty recognizing where things are in the environment
• May become angry if the activity speed is too fast
Degrees of Severity
The symptoms experienced and behaviors demonstrated by people \Nith sensory processing
dysfunction may differ significantly given the type and severity of the problem. The following
list is very general and is not all-inclusive. It is meant to serve only as a guide.
• Mild: refers to mild symptoms influencing a person's ability to self-organize and
functionally perform meaningful and purposeful activities, which may result in anxiety,
tension and/ or problems with mood and emotion regulation. This often impacts the type
aml l_lUalHy of Ll1e µersuri's imerauiurn, aml/u1 [heir abiliL-y rn comfunably parlicipc:1le in
activities of daily living. The person may or may not recognize it as a problem, and it may
or may not interfere vvith self-actualization, self-esteem and mental health issues.
• Moderate: refers to moderate symptoms influencing a person's ability to self-organize and
functionally perform meaningful and purposeful activities. People experiencing moderate
levels of severity may demonstrate any combination of the following behaviors: more
severe anxiety responses, rigidity, obsessive and/or compulsive behaviors, outbursts and/or
isolation. Problems with mood and emotion regulation are typically apparent. The impact
on the person's ability to function becomes more easily recognizable, although the reasons
for such behaviors or responses may not be understood until explored. Thus, coexisting
mental health issues, self-esteem and the ability to self-actualize are often impacted.
• Severe: almost every aspect of an individual's ability to function is significantly influenced
when symptoms are in the severe range. It often becomes extremely difficult to engage in
meaningful and purposeful activities in a functional manner. These individuals often carry
numerous diagnostic labels, and may have difficulty with developing and maintaining
close relationships, and with feeling purposeful. Self-esteem is often low, and quality of
life tends to depend largely upon the quality of services the person receives, and whether
or not they have appropriate levels of assistance and supportive relationships.
Facilitating Awareness, Hope and Recovery

It is not uncommon for people experiencing mild symptom severity levels to be unaware
of their condition. "1 thought everyone felt the same way" is a common response when first
becoming aware of one's unique systems tendencies and preferences. Others may be well
aware and may have developed coping skills or rituals in order to function more optimally.
"I just make sure that I get up before anyone in my house so that I can do things the way
I need to." Awareness leads to the ability to better understand and address one's sensory
tendencies and patterns if needed.
Dynamic human systems are sensitive to initial conditions, and seemingly small interventions
may lead to large effects. Increased awareness of one's sensory tendencies leads to better
understanding of the sources of one's frustrations, and to the ability to explore ways to
function more optimally and to change these tendencies when to do so is preferred. In
this way, increased awareness may ultimately lead to increased functional performance,
increased hope, and recovery.

Self-rating Scales: Measuring System Responses
In addition to the interview process (whenever possible), a self-rating scale (like the one
shown in Figure 5) can be used to measure a system response. Self-rating scales often assist
in identifying what is helpful and/ or aversive to an individual.
Figure 5: A Continuum of Hypo- and Hypersensitivity Tendencies

"Not enough" "Too much"
0 1 2 3 4 5 6 7 8 9 10
The use of self-rating tools is often very helpful to individuals who are assessing and learning
about their system tendencies and to staff and caregivers trying to understand the individual's
needs and provide optimal supports. Increasing self-awareness is one of the first goals of the
sensory modulation program (discussed in the next section), and self-rating tools may be
used as part of the program with individuals capable of using them. The resource section of
this manual provides a host of self-rating tools to use during group or individual sessions.
These tools are labeled with a variety of titles so that the san1e tool can be used for a number
of therapeutic purposes. It is important to adapt self-rating tools to match the ability levels
and needs of the individuals using them. Many of these tools were created with consumer
input over time. Examples of how to use some of the different self-rating tools are provided
in the Chapter III of this manual.
Common Interventions: Sensory Processing Issues

The assessment process helps to identify the order parameters, which aids in the ability to
collaboratively choose the most helpful therapeutic challenges (interventions), as reviewed
in Table 5. According to Miller (2006), people with problems with sensory processing often
have issues with hyperarousal. Although human systems are unpredictable, it is particularly
important that responsible practice proceeds with caution, so tl1at the individual does not
become overwhelmed unnecessarily. Therapeutic exchanges are always, in and of themselves,
ongoing assessment processes. It is sometimes difficult, however, to ascertain whether or not an
intervention is helpful, since there is often some degree of destabilization prior to bifurcation
and phase transition (the emergence of new attractor patterns or change). These issues further
underscore the necessity of the centrality and active participation of the consumer in all
aspects of the assessment and therapeutic intervention processes whenever possible.

The Structural and Process Elements of SI Fidelity
Structural elenients include:
• Room set-up (e.g., types of equipment, safety provisions, space)
• Therapist training
• Therapist-child ratio
Process elements include therapeutic techniques that are consistent with the underlying
philosophical principles of SI, such as:
• Physical safety
• Establishing a therapeutic alliance
• Collaborating with the child on activity choice
• Tailoring auivilie::i LU pre::iem "ju::iL Ll1e riglu challenge"
• Ensuring successful activity performance
• Sensory opportunities (at least tvvo of the following: vestibular, tactile, proprioceptive)
• Supporting optimal alertness and affect
• Challenging postural, ocular, oral processing or bilateral motor control
• Challenging praxis and organization of behavior
• Supporting motivation to play
Koomar, Parham and Smith Roley (2007) emphasized that just calling a therapeutic intervention
"SI" does not make it so. The need to decrease the ambiguous nature of ASI is evident and it is
necessary to ensure that the practice patterns, when using sensory approaches, are accurately
described and researched to assist in the mission of promoting evidence-based practices.
Sensory Approaches and National Initiatives in Mental Health

Interestingly, Ayres (1974, 1979) was an occupational therapist and child psychologist whose
research included the study of traumatized animals. She noticed similar patterns between
those in the animal studies and some of the children she worked with. Currently, one of
the national initiatives in mental health practice is to increase trauma-informed care, and
it is not surprising that at the same time senso1y processing-related approaches have been
increasingly sought out and applied. This is true even with the older adolescent, adult and
geriatric populations. While these are not the sole reasons for the application of sensory
approaches to mental health practice, some of which were used by many practitioners before
these initiatives took place, national initiatives in mental health have increasingly promoted
the use of sensory approaches in mental health settings (National Executive Training Institute
[NETll, 2003, 2006; Champagne, 2003b, 2005, 2006a, 2007a, 2007b; Champagne, Koomar &
Olson, 2010; Champagne & Maclachlan, 2006; Champagne & Stromberg, 2004; Moore,
2005; Mullen et al., 2008). Many of these sensory approaches used in general mental health
settings have been taken or adapted from those initially promoted by Ayres.
Lorna Jean King (1974) was one of the first occupational therapists documented who
attempted to use ASI approaches with people with schizophrenia. Mildred Ross (Ross &
Burdick, 1981; Ross, 1998a, 1998b) is also well known for applying sensorimotor approaches
when working with mental health and geriatric populations with developmental disabilities
and severe cognitive impairment. Since there was not, however, the degree of clarification as
to what specifically constituted ASI versus more generalized sensory approaches, the term
"sensory integration" was often, unknowingly, used loosely in previous works. Interestingly,

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Mataï-aoueraï West or S. W. wind.
Matao Fish-hook.
Matapo One-eyed, squinting.
Matari The Pleïades.
Matïe Grass-herbage.
Mato Mountain.
Mate To kill.
Mea A thing (chose.)
Meia Banana-tree, bananas.
Metoua Parents. Metouatane, or eoure,
father; Metouaaine, or erao,
mother.
Mimi To make water, to piss.
Móa Cock, hen.
Moea Mat.
Mona Fine, good.
Moreou A calm.
Motoua Grand-son.
N.
Nate To give.
Nie A sail of a boat.
Niouniou A jonquil.
O.
Oaï Walls and stones.

Oaite To open.
Oorah The piece of cloth which they
wrap themselves in.
Ooróa Generous, he that gives.
Opoupoui To drink.
Oualilo To steal, to rob.
Ouaouara, Aigret of feathers.
Ouaora To cure, or cured.
Ouanao To ly in.
Ouare To spit.
Ouatere The helm’s-man.
Ouera Hot.
Oueneo That does not smell well, it
infects.
Ouetopa To lose, lost.
Ouhi Ho! ah! (hé.)
Ouopé Ripe.
Oupani Window.
Oura Red.
Ouri Dog and quadrupeds.
P.
Pai Periagua.
Paia Enough.
Papa Wood, chair, end every piece of
furniture of wood.
Papanit To shut, to stop up.
Paoro A shell, mother-of-pearl.
Parouai Dress, cloth.
Patara Grandfather.
Patiri Thunder.
Picha Coffer, trunk.
Pirara Fish.
Piropiro Stink of a fart, or of excrements.
Pirioi Lame.
Piripiri A negative, signifying a covetous
man, who gives nothing.
Po Day, (light.)
Póe Pearl, ornament for the ears.
Poi For, to.
Poiri Obscure.
Poria Fat, lusty, of a good stature.
Porotata Dog-kennel.
Pouaa Hog, boar.
Pouerata Flowers.
Poupoui Under sail.
Pouta Wound.
Poto Little, minute.
I know no word that begins with Q.
R.
Rai Great, big, considerable.

Ratira Old, aged.
Roa Big, very fat.
Roea Thread.
No word is come to my knowledge beginning with

S.
T.
Taitai Salted.
Taio Friend.
Tamai Enemy, at war.
Tane Man, husband.
Tao-titi Name of the high priestess, who
is obliged to perpetual
virginity. She has the highest
consideration in the country.
Taoa-tane Married woman.
Taporai To beat, abuse.
Taoua-mai Physician.
Taoumi Gorget of ceremony.
Taoumta Covering of the head.
Taoura Cord.
Tata Man.
Tatoue The act of generation.
Tearea Yellow.
Teouteou Servant, slave.
Tero Black.
Tetouarη Femme barée?
Tiarai White flowers, which they wear
in their ears instead of
ornaments.
Titi A peg, or pin.
Tinatore A serpent.
Twa Strong, malignant, powerful.
Tomaiti Child.
Toni Exclamation to call the girls.
They add Peio lengthened, or
Pijo softly pronounced, like
the Spanish j. If the girl slaps
her hand on the outside of the
knee, it is a refusal, but if she
says enemoi, she thereby
expresses her consent.
Toto Blood.
Toua-pouou Hump-backed.
Touaine Brother or sister, by adding the
word which distinguishes the
sex.
Toubabaou To weep.
Touie Lean.
Toumany Action of fencing; this they do
with a piece of wood, armed
with a point, made of harder
materials than wood. They put
themselves in the same
posture as we do for fencing.
Toura Without.
Toutai To make the natural
evacuations.
Toutη Excrements.
Toupanoa To open a window or door.
Touroutoto A decrepit old man.
Toutoi-papa Light or fire of the great people;
niao-papa, light of the
common people.
V.
Vereva Flag which is carried before the

king and the principal people.
I know no words beginning with the letters U, X, Y,
Z.
Names of different parts of the body.
Auopo The crown of the head.
Boho The skull.
Eouttou The face.
Mata The eyes.
Taria The ears.
Etaa The jaw.
Eiou The nose.
Lamolou The lips.
Ourou The hairs.
Allelo The tongue.
Eniou Teeth.
Eniaou. Tooth-picks, they make them of
wood.
Oumi The beard.
Papaourou The cheeks.
Arapoa The throat.
Taah Chin.
Eou Teats, nipples.
Asao The heart.
Erima The hand.
Apourima The inside of the hand.
Eaiou The nails.
Etoua The back.
Etapono The shoulders.
Obou The bowels.
Tinai The belly.
Pito The navel.
Toutaba The glands of the groin.
Etoe Buttocks.
Aoua Thighs.
Eanai Legs.
Etapoué The foot.
Eoua Testicles.
Eoure The male parts.
Erao The female parts.
Eomo The clitoris.
Numerals.
Atai One.
Aroua. Two.
Atorou Three.
Aheho Four.
Erima Five.
Aouno Six.
Ahitou Seven.
Awarou Eight.
Ahiva Nine.
Aourou Ten.
They have no words to express eleven, twelve, &c.

They repeat Atai, Aroua, &c. till to twenty, which
they call ataitao.
Ataitao-mala- Twenty, more one, or twenty-

atai one, &c.
Ataitao-mala- Thirty, i. e. 20 more 10.
aurou
Aroua-tao Forty.
Aroua-tao mala Forty-three, &c.
atorou
Aroua-tao mala Fifty, or 40 more 10.
aourou
I could not make Aotourou count beyond his last

number.
Names of Plants.
Amiami Raisins.
Oporo-maa Pepper.
Pouraou Cayenne-rose.
Toroire Heliotropium, or tournesol.
They have a kind of article answering to our articles of and to (de
& à). This is the word te. Thus they say parouai te Aotourou; the
clothes of or (belonging) to Aotourou; maa-te-eri, the eating of
kings.
THE END.
ERRATA.
Page 2, line last, for main-yards, read lower-yards—p. 9. l. 3, for

one quarter, read by—ib. l. ib. for one quarter, read by—ib. l. 6. for
one quarter, read by—p. 17. l. 16. for the river of Plate, read Rio de
la Plata—p. 33. l. 15. for top-masts handed, and main-yards
lowered, read yards and top-masts struck—ib. l. 19. for main-sails
read courses and top-sails—p. 34. l. 12. for one quarter, read by—p.
245. note, l. 1. for cooes nutisera, read cocos nucifera—ib. l. 2. for
parasidiaca, read paradisiaca.
Foonotes
1. We have thought proper to omit M. Pereire’s discourse on the

nature of the language of Taiti, as being a very trifling performance,
founded on the imperfect vocabulary, and defective pronunciation of
Aotourou.
2. North Sea signifies here the Atlantic Ocean, and is put in

opposition to South Sea; the former taking in the ocean on this side
the Magellanic straits, the latter that which is west of them. The
appellation, though somewhat improper, by calling the sea about the
south pole the North Sea, is however sometimes employed by some
writers. F.
3. Dom Pernetty, in his Dissertation upon America, speaks of a
voyage round the world, in 1719, by captain Shelvock; I have no
knowledge of this voyage. Note of Mr. de B.
As M. de Bougainville’s list of circumnavigators is very imperfect,
we will endeavour to give a more compleat one in few words.
1. Fernando Magalhaens, 1519.
2. Sir Francis Drake sailed from Plymouth the 15th of November,
1577, but was obliged to put back on account of a storm; after
which, he set sail again the 13th of December, and returned the 16th
of September, 1580.
3. Sir Thomas Cavendish, 1586-88.
4. Simon de Cordes, a Dutchman, sailed in 1598-1600.
5. Oliver Van Noort sailed the 13th of September, 1598, and
returned the 22nd of August, 1601.
6. George Spielbergen, a German in the Dutch service, 1614-1617.
7. William Cornelius Schouten with Jacob Le Maire, 1615-1617.
8. Jacob l’Hermite with John Hugo Schapenham sailed from
Goeree, in the province of Holland, the 29th of April, 1623, and
arrived in the Texel the 9th of July, 1626.
9. Henry Brouwer, a Dutchman, in 1643.
10. Cowley, in 1683-1686.
11. William Dampier, an Englishman, sailed in 1689, and returned
1691. He has been omitted by M. de Bougainville in the list of
circumnavigators, because he did not go round the world in one and
the same ship.
12. Beauchesne Gouin, in 1699.
13. Edward Cooke, an Englishman, made the voyage in the years
1708 and 1711. 14. Woodes Rogers, an Englishman, sailed from
Bristol, June 15th, 1708, and returned 1711.
15. Clipperton and Shelvocke, two Englishmen, sailed the 13th of
February, 1719, and returned in 1722; the former to Galway in
Ireland, in the beginning of June, the latter to London, on the first of
August.
16. Roggewein, a Mecklenburger, in the Dutch service, sailed the
16th of July, 1721, and returned the 11th of July, 1723.
17. Lord Anson, 1740-1744.
18. Commodore Byron, 1764-1766.
19. The Dolphin and Swallow sloops. The first 1766-1768. The
second 1766-1769.
20. M. de Bougainville, 1766-1769.
21. The Endeavour sloop, captain Cooke, which sailed in August,
1768, to observe the transit of Venus, came to Batavia the latter end
of 1770, and returned to England in July 1771.
From this list, it appears that the English have undertaken the
greatest number of voyages, with a design to make discoveries,
unattended by that selfishness with which most of the Dutch
voyages were entered upon, merely with a view to promote the
knowledge of geography, to make navigation more safe, and likewise
to throw further lights on the study of nature. F.
4. The author is very solicitous to exclude le Gentil de la Barbinais

from the honour of being the first circumnavigator of the French
nation, in order to secure it to himself; though it is a real
circumnavigation. The famous Italian, Giovan Francisco Gemelli
Carreri, cannot with propriety be called a circumnavigator, though he
made the tour of the globe in the years 1693-1698, for he landed in
Mexico, and crossed America by land, and went again to the Manillas
by sea, and from thence to China and Europe on board of other
ships. F.
5. Not from the discoverer, but from the ship Eendraght (Concord).
6. The mistakes and omissions of our author in regard to these

navigators of the South Seas, who did not sail round the world, are
various and multifarious; but it would take up too much time to point
them all out; and as there is a very complete list of all the navigators
of the Pacific Ocean, in the Historical Collection of the several
Voyages and Discoveries in the South Pacific Ocean, published by
Alex. Dalrymple, Esq. we refer our readers to it. F.
7. The officers on board the frigate la Boudeuse, were M. de

Bougainville, captain of the ship; Duclos Guyot, captain of a fire-
ship; chevalier de Bournand, chevalier d’Oraison, chevalier du
Bouchage, under-lieutenants (enseignes de vaisseau); chevalier de
Suzannet, chevalier de Kué, midshipmen acting as officers; le Corre,
super-cargo (officier-marchand); Saint-Germain, ship’s-clerk; la Veze,
the chaplain; la Porte, surgeon.
The officers of the store-ship l’Etoile, consisted of M. M. Chenard
de la Giraudais, captain of a fire-ship; Caro, lieutenant in an India-
man; Donat, Landais, Fontaine, and Lavary-le-Roi, officiers
marchands; Michaud, ship’s-clerk; Vivez, surgeon.
There were likewise M. M. de Commerçon, a physician; Verron, an
astronomer, and de Romainville, an engineer.
8. It would be improper to derogate from the merit of any nation,

unless that same nation intends to obtain it by destroying the
character of another. Had Mr. de Bougainville bestowed some
encomiums upon the zeal and courage of the officers under his
command, it would be thought that he were willing to do them
justice: but since he, without the least necessity, casts a reflection
upon the English officers in commodore Byron’s expedition, it is no
more but justice to retort the argument. It is an undeniable proof of
the badness of the constitution, and of the arbitrary government of a
country, when a set of worthy men, who have braved the most
imminent danger, with an undaunted courage, for the welfare of
their fellow-citizens, remain without any reward whatsoever, except
that philosophical one, the consciousness of good and laudable
actions. But it is likewise the best proof of the happiness of the
government and constitution of a country, when merit and virtue is
rewarded. These propositions are so evidently founded on truth, that
they want no further confirmation: and every true Englishman will
congratulate himself on the happiness to live under a government
which thinks it a necessary duty to reward zeal, courage, and virtue,
in a set of men who go through their duty with spirit and
chearfulness; and what honour must not redound on an
administration which forces, even a rival nation, to give an
honourable testimony to its attention in justly and conspicuously
rewarding merit in its fellow-citizens, at the same time that these
rivals endeavour to quiet the uneasy minds of their poor dissatisfied
officers, with a vain and empty compliment. F.
9. La flûte.
10. Though the name of this circumnavigator is frequently spelled

Magellan, it is, however, right to spell proper names as they are
written in their original language; according to this rule we shall
always write Magalhaens. F.
11. Land-fall, atterage, the first land a ship makes after a sea-
voyage. See Falconer’s Marine Dictionary. F.
12. It is now certain, that the animal, here called tyger, is the
Couguara or Brown (tyger) Cat, of Penn. Syn. quad. p. 179. a very
large animal, and very fierce in hot countries. F.
13. These balls are two round stones, of the size of a two-pound
ball, both enchased in a strap of leather, and fastened to the
extremities of a thong, six or seven feet long. The Indians, when on
horseback, use this weapon as a sling, and often hit the animal they
are pursuing, at the distance of three hundred yards.
14. The Paulists are another race of robbers, who left Brasil, and
formed a republic, towards the end of the sixteenth century.
15. Maté, or Paraguay-tea, or South-sea-tea, are pounded dry

leaves of a plant growing in South America, and chiefly in Paraguay.
The Jesuits, when in possession of the interior parts of the provinces
of Paraguay, got by a manœuvre similar to that of the Dutch, in
regard to the spice-trade, the exclusive commerce of this
commodity. They cultivated this plant in enclosures, upon the rivers
Uraguai and Parana, and wherever it grew wild, it was destroyed;
and after the space of nineteen years they became the sole masters
of this trade, which was very lucrative; for as this plant is thought to
be an excellent restorative, and a good paregoric, and therefore of
indispensible necessity to the workmen in the famous Peruvian
mines, it is carried constantly to Peru and Chili; the whole
consumption of it being yearly upon an average of 160,000 arrobas,
of 25 pounds Spanish weight each; and the price is, at a medium,
thirty-six piasters per arroba, so that this plant was worth to the
Jesuits 5,760,300 piastres per ann. the tenth part of which sum must
be deducted out of the whole, for instruments of agriculture, the
erection and repairing of buildings necessary for manufacturing this
plant, feeding and cloathing of about 300,000 Indians and Negroes:
so that still above five millions of piastres were the clear yearly profit
of the pious fathers. These cunning men sold these leaves in powder
on purpose that no botanist might get a sight of them, and thus be
enabled to find out the plant to which the leaves belong, in case
some plants should have escaped their selfish destruction of them.
Some writers call this plant Maté, which is, I believe, the name of
the vessel it is drank out of. Others call it Caa, and make this the
generic name of it, and its species are Caa-cuys, Caa-mini, and Caa-
guaz, the last of which is the coarsest sort prepared, with the stalks
left to it, for which reason it is likewise called Yerva de Palos; but the
Caa-mini or Yerva de Caamini is the best sort and sold dearer; the
Caa-cuys will not keep so long as the other two sorts. This plant is
thought to be the Ilex Cassine, Linn. Sp. pl. p. 181. or the Dahoon-
holly. Forster’s Flora Americ. Septentr. p. 7. and Catesby car. i. t. 31.
F.
16. When I delivered the settlement to the Spaniards, all the

expences, whatsoever, which it had cost till the first of April 1767,
amounted to 603,000 livres, including the interest of five per cent.
on the sums expended since the first equipment. France having
acknowledged the catholic king’s right to the Malouines, he, by a
principle of the law of nations, owed no reimbursement to these
costs. However, as his majesty took all the ships, boats, goods,
arms, ammunition, and provisions that belonged to our settlement,
he being equally just and generous, desired that we should be
reimbursed for what we had laid out; and the above sum was
remitted to us by his treasurers; part at Paris, and the rest at Buenos
Ayres.
17. The inscription on this medal was as follows.
Settlement of the Isles Malouines, situated in 51° 30′ of S.
latitude, 60° 50′ W. long. from the meridian of Paris, by the Eagle
frigate, captain P. Duclos Guyot, captain of a fire ship, and the
sphinx sloop; captain F. Chenard de la Giraudais, lieutenant of a
frigate, equipped by Louis Antoine de Bougainville, colonel of
infantry, captain of a ship, chief of the expedition, G. de Nerville,
captain of infantry, and P. d’ Arboulin, post-master general of France:
construction of a fort, and an obelisk, decorated with a medallion of
his majesty Louis XV. after the plans of A. L’Huillier, engineer and
geographer of the field and army, serving on this expedition; during
the administration of E. de Choiseul, duke of Stainville, in February,
1764.
And the exergue. Conamur tenues grandia.
18. An officer who has the care of the stores.
19. The author has on purpose omitted to mention, that the

English are the first discoverers of these isles. Captain Davis, in the
expedition of 1592, under the command of Sir Thomas Cavendish,
saw them; and so did Sir Richard Hawkins two years after in 1594,
and called them Hawkins’s Maiden Land. In the year 1598 they were
seen by the Dutchman Sebald de Waert, and called Sebald’s isles,
and with that name they were put in all Dutch charts. Dampier
discovered them likewise in 1683, but suspected they had no water.
Strong gave these isles, in the year 1689, the name of Falkland-
Islands, which was adopted by the celebrated astronomer Halley,
and is now become of universal use in all our maps and charts. The
privateers in the times of the wars of king William and queen Mary
frequently saw these isles, and no sooner than in 1699-1700 they
were seen for the first time by a Frenchman called Beauchesne
Gouin. It is pretty evident from this account, that the English have
an undoubted prior claim to these barren rocks and marshes,
situated in a cold climate, subject to the severest rigours of winter,
without the benefit of woods to alleviate them; and on which, was it
not for the wretched fuel of turf, all the French, English, and Spanish
settlements would have been starved with cold. F.
20. The work which I now publish was already finished, when the
History of a Voyage to the Malouines, by Dom Pernetty, appeared,
otherwise I should have omitted the following accounts.
21. As M. de Bougainville’s map of the Malouines or Falkland’s

isles, is a mere inaccurate out-line; we refer our readers to the more
exact plans of these islands, published in England. F.
22. Euphorbia Linn. Tithymalus Tournef. F.
23. Ceterae Asplenium, Linn. F.
24. Lepas Linn.
25. Buccinum Linn.
26. Ostreæ Pectines Linn.
27. Mya Linn. F.
28. For a navigator, of Mr. Bougainville’s experience and abilities,

this query is very extraordinary; and, still more so, for a man who
has spent so many years in Canada, near the coasts of Labrador;
and who certainly must have read accounts from Greenland, where
often land-animals, on large masses of ice fixed to the shore, and
broke loose by the sea, are driven into the ocean; and again landed
on the shores of countries, very distant from their native home. F.
29. In the northern parts of America is a kind of wild goose, which

was called by the French, when in possession of Canada, Outarde,
or Bustard; the English call it the Canada-goose; it has been
represented by Catesby, I.t. 92. Edward t. 151. and the Planches
Enluminées, t. 346. Perhaps this may be the same species. F.
30. This bird, though the author calls it a Diver, seems, according
to the description of it, to be rather the Grebe; which is so plentiful
on the lake of Geneva, whose beautiful skins are drest, and made
into muffs and tippets. Br. Zool. 2. p. 396. 8vo. Ed. F.
31. This species seems to be the white and dusky grebe. Br. Zool.
2. p. 397, and vol. 4. f. 17. F.
32. Becs-scies.
33. As far as we can guess, from this very imperfect description,

the birds here mentioned seem to be of the kind called Guillemot. Br.
Zool. vol. 2. p. 410. and vol. 4. t. 20. F.
34. The Quebrantahuessos is a bird belonging to the genus called

by Dr. Linnæus, Procellaria, or petrel; some of the sailors call it
Albatross, but then we must take care not to confound the common
albatross, represented by Mr. Edwards, tab. 88, which is not this
Quebrantahuessos, but I believe the bird described by our author to
be not yet well known by our ornithologists; and the imperfect
account of Bougainville and Dom Pernetty are far from being
satisfactory to natural historians. Our late great circumnavigators
and philosophers will probably oblige the literary world with a
drawing and account of this bird. F.
35. Nenuphars, Nymphæa Linn, F.
36. The place referred to here in Lord Anson’s Voyage is book I.

chap. vii. p. 92. edit. 14th, in 8vo. 1769; but from thence, as well as
from our author’s account, it is impossible to determine which
species of the penguin is meant. F.
37. The first of these penguins seems to be that described by Mr.

Pennant in the Philos. Trans. vol. lix. and represented in an accurate
drawing. F.
38. Aigrette, a species of heron.

39. This last species of penguin, or auk, seems to be the same
with the alca cirrhata of Dr. Pallas, Spicileg. Zool. Fasc. v. p. 7. tab. i.
& v. fig. 1-3. F.
40. The author certainly has the noted fable of the antients in
view, according to which, the alcyons had a swimming nest, and
brooded at sea at a time in winter, when the weather was calm. The
few calm days during which these birds were employed in brooding,
were therefore called alcyonia. F.
41. The two petrels here mentioned seem to be the little, and the
sea-swallow or frigat; the first of which is described, Br. Zool, vol. ii.
p. 434, and represented, vol. iv. t. 82. The second, or swallow petrel,
or frigat, is to be met with in Rochefort’s Voyage, t. 135. Dr. Linnæus
calls the first procellaria pelagica, the latter the fregatta, and, if I am
not mistaken, the third kind here mentioned, is, the fulmar, Br. Zool,
vol. ii. p. 431. and vol. iv. t. 82. Dr. Linnæus’s Procellaria glacialis. F.
42. The sea-pie is sometimes called oyster-catcher, because this

bird forces the shells open with its bill, which are left bare on the
shore, at the recession of the tide. Br. Zool, vol. iv. p. 376, Dr.
Linnæus’s Hæmatopus Ostralegus. F.
43. This seems to be the American red-breast, or turdus

migratorius, Linn. and Kalm’s Voyage, vol. ii. p. 90, where likewise a
figure of it is given. F.
44. Glayeuls.
45. The animal here mentioned as the true sea-lion exceeds the
sea-lion described in Lord Anson’s Voyage; for this is twenty-five feet
long, and that in the isle of Juan Fernandes only twenty. See Voyage
aux Isles Malouines, par Dom Pernetty. F.
46. Muge ou mulet.
47. Brochet transparent.

48. This kind of trout has been likewise mentioned in a pamphlet
published last winter about the Falkland isles. F.
49. Debouché.
50. Intendant.
51. Capitainie.
52. Upwards of 450,000 pounds sterling; at 4 s. and 6 d. per

dollar.
53. Buccarelli.
54. Virer en quille.
55. Chambekin.
56. Chambekins.
57. The Jesuits in Paraguay have been so much the object of

private conversation, and of public contest, that it is a wonder the
public is still at a loss, in regard to the real situation of their affairs.
The account published here by Mr. Bougainville, must, no doubt,
greatly contribute to throw a light on the transactions in Paraguay, of
which so little is known with any degree of certainty. A few remarks
taken from the ingenious Marquis de Pau’s Recherches sur les
Americains, will, we hope, not be disagreeable to the readers.
In the year 1731, the Audiença of Chuquisaca, in the province of
los Charcas, found it necessary to empower the Protector of the
Indians, i. e. the solicitor general for them, and a member of their
body, to visit the famous Paraguay missions, and to inquire into the
truth of the various unfavourable reports spread about them. Don
Joseph de Antequera, a man of abilities, great integrity, and superior
courage, was then invested with the dignity of Protector of the
Indians. Accompanied only by one Alguazil Mayor, called Joseph de
Mena; and with the deed, impowering him with the visitation of the
missions, he went with spirit on his business; and after his arrival at
the city of Assumption, he acquainted the Jesuits with the
commission. The reverend fathers told him, that he had taken in
vain the pains of coming to their missions, where he would never get
admittance; and if he should attempt to force his way, he would
repent of it. Antequera did neither know the bad character of these
people, nor did he fear their threats, and went therefore on his
intended journey. But he was soon surrounded by a large
detachment of armed Indians, with Jesuits at their head, who fell
upon him; and he escaped by a sudden flight only.
The unfortunate Alguazil, being willing to encounter a German
Jesuit, was dangerously wounded. The Jesuits, not contented with
this inconsiderate step, accused Antequera, as an adventurer, who
had attempted to assume the dignity of a king of Paraguay, at the
city of Assumption; but that the reverend fathers, as faithful subjects
to his Catholic Majesty, had driven him out by main force; and they
requested, therefore, to be recompensed for this signal service to
their sovereign.
Don Armendariz, Marquis de Castel Fuerte, thirty-third viceroy of
Peru, entirely devoted to the Jesuits, sent Don Joseph de Antequera,
in consequence of this accusation, immediately to a dungeon. He
was examined; and though his counsellors had written five thousand
sheets in his defence, he was, however, hanged for the crime of
revolting against his sovereign, the fifth of June, together with his
assistant Joseph de Mena, who was still very ill from the wound
received at Assumption.
Lima and all Peru revolted against their viceroy, on the account of
so shocking and tyrannical an action. The troops were sent to quell
the riots. The blood of thousands flowed in the streets of Lima, and
stained the vallies of Peru. All the men of integrity and honour at
Lima, Cusco, Cuença, and Chuquisaca took up mourning for
Antequera, the innocent victim of the revenge of the pious fathers,
and of the despotism of the arbitrary viceroy, their tool. This
transaction ruined the credit of the Jesuits in Peru.
The reverend missionaries found means to settle extensive
establishments on the Uraguay, and the interior parts of Paraguay,
upon the Pilco Mayo, and other rivers. They collected first, by gentle
means, some of the Indian tribes into small settlements, taught
them husbandry, and the most necessary arts; and afterwards,
music, painting, and sculpture; all were instructed in the use of
arms. By the help of these first colonies, they often forced the free
rambling tribes of interior America, under the holy yoke of the
gospel, and into subjection to these zealous missionaries. The poor
wretches were then cloathed with a callico shirt, and got their
allowance of meat, maize, and caamini; but they were in return
obliged to drudge for the good fathers, in planting the Paraguay tea,
cotton, tobacco, and sugar. Every ounce of cotton and caamini raised
by these slaves must be delivered into the society’s storehouses,
from whence they were transported and sold for the benefit of the
missionaries: those who concealed any of the above articles, got
twelve lashes, in honour of the twelve apostles, and were confined
to fasting during three days in the public work-house. Benedict XIV.
the head of the Romish church, a man, whose humanity and
extensive learning is so universally known, published two bulls
against the Jesuits, wherein he excommunicates them, for the
practice of enslaving the poor proselytes, and keeping them no
better than animals; (whom men deprive of their liberty, and
domesticate them with a view of making use of them in the most
laborious employments) and for using religion as a cloak to
oppression, despotism, and tyranny; in order to deprive free-born
beings and their fellow-creatures of liberty, the first and most
precious of all their enjoyments and privileges in this present life.
These bulls will be for ever the strongest proofs of the truth of these
assertions, and of the specious tyranny of the Jesuits.
The iniquitous practices in regard to the trade of the Paraguay-tea,
are so well dated, that whole tribes of Indians were brought to the
dilemma either to enlist as bondmen to the Jesuits, or to be starved;
the complaints of so many Indian plantations of South-Sea tea
destroyed by the Jesuits, were always heard, examined, and
reported to the court of Spain; but the influence of the Jesuits
prevented the council of the Indies from taking any steps for the
punishment of the pious fathers; and they would still remain
unknown and unpunished, had not this society been so suddenly
involved in their ruin, by the precaution of the court of Spain. F.
58. Chaines de haubans.
59. Cap des Vierges, called Cape Virgin Mary by Lord Anson and
Sir John Narborough. F.
60. 74° 25′; Paris being 2° 25′ E. from London: vide Ferguson’s
Tables. F.
61. From Cape Virgin, till to the entrance of the first goulet, we
may reckon 14 or 15 leagues; and the straits are in every part of this
interval, between five and seven leagues wide. The north coast, as
far as Cape Possession, is uniform, but little elevated, and very
healthy. From this cape onward, one must be careful to avoid the
rocks, which are situated in a part of the bay of the same name.
When the hillocks, which I have named the Quatre fils Aymond,[62]
only offer two to sight, in form of a gate, you are then opposite the
said rocks.
62. These rocks are called Ass’s Ears, by Sir John Narborough. F.
63. When one intends to enter the first gut, or narrow passage in
the straits, it is proper to coast within a league of Cape Possession;
then to steer S. by W. taking care not to fall off too much to the
south, on account of the rocks which extend N. N. E. and S. S. W.
from Cape Orange, more than three leagues.
64. The first gut lies N. N. E. and S. S. W. and is not above three
leagues long. Its breadth varies from a league, to a league and a
half. I have already given notice of the ledge of rocks at Cape
Orange. At coming out of the first gut, you meet with two lesser
rocks, extended on each of its extremities. They both project to S.
W. There is a great depth of water in the gut.
65. This is to be understood in French measure, in which the
French foot exceeds the English by ,788 of an inch; accordingly, in
French measure, 5 feet 6 inches = 5 feet, 10,334, inches English;
and French 5 feet 10 inches are = 6 feet, 2,5704, inches English. F.
66. A mer étale.
67. The distance between the W. point or end of the first gut, and
the entrance of the second, is about six or seven leagues, and the
breadth of the straits there is likewise about seven leagues. The
second gut lies N. E. by E. and S. W. by W. it is about a league and a
half broad, and three or four long.
68. In passing the second gut, it is necessary to keep along the

coast of Patagonia, because, when you come out of the gut, the
titles run southward, and you must be careful to avoid a low point,
projecting below the head-land of St George’s isle, and though this
apparent cape is high and steep, the low land advances far to W. N.
W.
69. The isle of Elizabeth[70] lies N. N. E. and S. S. W. with the west

point of the second gut, on the Patagonian side. The isles of St.
Barthelemi (St. Bartholomew) and of Lions likewise, lie N. N. E. and
S. S. W. between them and the west point of the second gut on St.
George’s island.
70. The French call it Sainte Elizabeth. F.
71. The isles of St. Barthelemi and of Lions, are connected

together by a shoal. There are likewise two shoals; one S. S. W. of
the isle of Lions, and the other W. N. W. of St. Barthelemi, one or
two leagues distant; so that these three shoals, and the two isles
form a chain; between which, to E. S. E. and the isle of St. Elizabeth
to W. N. W. is the channel through which you advance into the
straits. This channel runs N. N. E. and S. S. W.
I do not think it practicable to sail on the south side of the isles of
St. Barthelemi and of Lions, nor between the isle of Elizabeth and
the main land.
72. From the end of the second gut, to the N. E. point of the isle
of Elizabeth, the distance is about four leagues. Elizabeth island
extends S. S. W. and N. N. E. for the length of about three leagues
and a half. It is necessary to keep this shore on board, in passing
through the above channel.
From the S. W. point of Elizabeth island, to Cape Noir, the distance
is not above a league[73].
73. This Cape Noir is not mentioned in M. de B’s. map; but should
be carefully distinguished from Cape Noir, or Cabo Negro, seen by
lord Anson upon Terra del Fuego, in about 54° S. lat. F.
74. From Cape Noir the coast runs S. S. E. to the northern point of
Bay Duclos; which is about seven leagues distant from it.
Opposite Bay Duclos, there is a prodigious inlet in Terra del Fuego;
which I suspect to be a channel, disemboguing eastward of Cape
Horn. Cape Monmouth forms the north point of it.
75. Perruches, probably sea-parrots, or auks. F.
76. The distance from Bay Duclos to Point St. Anne, is about five
leagues; and the bearing being S. E. by S. there is nearly the same
distance from Point St. Anne to Cape Round, which bear respectively
N. N. E. and S. S. W.
77. From the second gut to Cape Round, the breadth of the straits
varies from seven to five leagues; they grow narrow at Cape Round,
where their breadth does not exceed three leagues.
78. From Cape Round, to the Isle of the Observatory, the distance
is about four leagues; and the coast runs W. S. W. In this distance
there are three good anchoring-places.
79. A French toise is six feet Paris measure. F.

80. A mi-canal.
81. From the isle of the Observatory, Cape Forward is about six
leagues distant, and the coast runs nearly W. S. W. The strait is
there between three and four leagues broad.
82. In the space of about five leagues, which are between Cape
Forward and Cape Holland, there are two other capes, and three
creeks, of little depth. I know of no anchorage there. The breadth of
the straits varies from three to four leagues.
83. Cape Holland and Cape Galant bear among themselves E. 2°

S. and W. 2° N. and the distance is about eight leagues. Between
these two capes there is one, less projecting, called Cape Coventry.
They likewise place several bays there, of which we have only seen
Bay Verte, or Green Bay, or Bay De Cordes, which has been visited
by land. It is great and deep, but there seem to be several shallows
in it.
84. Bay Fortescue is about two miles broad from one point to the
other, and not quite so deep, from its entrance, till to a peninsula,
which, coming from the west-side of the bay, extends E. S. E. and
covers a port, well sheltered from all the winds. This is Port Galant,
which is a mile deep towards the W. N. W. Its breadth is from four
hundred to five hundred yards. There is a river at the bottom of the
port, and two more on the N. E. side. In the middle of the port there
is four or five fathoms of water, bottom of ooze and shells.
85. Sir John Narborough. F.
86. Laurier-epice, spice-laurel is probably the famous Winters-

bark, mentioned by Sir John Narborough, and afterwards well drawn
and described by Sir Hans Sloane, in his History of Jamaica, vol. ii. p.
87. t. 19. f. 2. and Plukenet. Almagest. 89. t. 81. f. 1. and t. 160. f. 7.
F.
87. From Cape Galant to Bay Elizabeth, the coast runs nearly W.
N. W. and the distance from the one to the other, is about four
leagues. In this space there is no anchoring-place on the main-land.
The depth is too great, even close to the shore. Bay Elizabeth is
open to the S. W. Its breadth between the points is three quarters of
a league; and its depth pretty near the same. The shore in the
bottom of the bay is sandy; and so is the S. E. shore. In its northern
part lies a ledge, stretching a good way to the offing. The good
anchoring in this bay is nine fathom, bottom of sand, gravel, and
coral; and has the following marks: the E. point of the bay bears S.
S. E. ½E. its W. point, W. b. N. The E. point of the isle of Louis le
Grand, S.S. W. ½S. the ledge N. W. b. N.
88. This complaint of our author is applicable only to the French

publications, for it is well known that the English voyages, chiefly
when published by authority, are remarkable both for the fine
language, and the strict keeping of the marine phrases, so necessary
to make these publications useful to future navigators, and which
are understood by the greater part of this nation, so much used to
the sea and its phrases, that our romances and plays are full of
them, and that they have even a run in common life. F.
89. It must be supposed, that the author means South America. F.
90. Mr. Bougainville writes David: indeed, he and most writers of

his nation, mutilate all foreign names; not only inadvertently, but
often on purpose, through mere caprice. F.
91. A Mecklenburger, who, with his father, had been in the Dutch
service. F.
92. A kind of sea-fowl; probably of the gull or tern kind. F.
93. Isle of Lancebearers.
94. Rester en travers.

95. The continent, which the geographers place in these parts,
ought to have been laid down only as a sign of land, which Quiros
says he met with the 27th of January 1606. But these signs of
continent Quiros found before he came to the isle of Sagittaria,
which is the first he landed at, after sailing from Peru. See Mr.
Dalrymple’s Historical Collection of Voyages in the South Pacific
Ocean, part i. 107, 108, and the chart of the South Seas annexed. F.
96. Reaumur’s.
97. The people of Otahitee, or as our author wrongly calls it, Taiti,
are not idolaters, according to the last published account, and
therefore it is certain, that Mr. de B. took some ornamental figures
for those of their divinities. Had this circumnavigator made a longer
stay in this island, had he thoroughly studied the language of the
country, and looked upon many things with a more philosophical, or
less prejudiced eye, his account would have proved less subject to
the mistakes it abounds with. The English, more used to
philosophical enquiries, will give more faithful accounts in the work
that is going to be published, of the great discoveries made by the
British nation in those seas. F.
98. Rayés.
99. The cocoa-nuts, or the fruit of the cocos nucifera, Linn. is too
well known to want any description. The plantains, or fruit of the
musa paradisiaca, Linn. is likewise well known to all navigators, as
the produce of hot countries. The bread-fruit is a production of a
tree not yet described by Dr. Linnæus; Lord Anson found it upon the
isle of Tinian; Dampier and the great Ray take notice of this very
useful and curious tree. Yams are the roots of a plant known under
the name of dioscorea alata. The okra is the fruit of the hibiscus
esculentus, Linn. The curassol is one of the annonas or custard-
apples. In general it must be observed that the botanical knowledge
of our author is very superficial, and though he enumerates these
fruits as the growth of the isle of Otahitee, it cannot be ascertained
with any degree of precision, whether our author is right or wrong;
and the new light in which, by the indefatigable industry of our
philosophers, the natural history of these countries will be placed,
makes us the more ardently wish for the publication of their great
discoveries. F.
100. This assertion of Mr. de B. proves him to be little acquainted

with mining; since our best writers on that subject give a gently
sloping ridge of mountains, with a fine turf, covered with groves of
trees, and well supplied with water, amongst many more, as the
characteristics of a place where it is probable to find minerals in: See
Lehman’s Art des Mines Metalliques, vol. i. p. 17. But the whole isle
of Otahitee seems to be produced by a Volcano, and the rocks on it
are chiefly lava, consequently there are very little hopes of finding
any regular veins with minerals on it, except some iron-stone, which
has been liberally scattered by the benevolent hand of nature all
over the various parts of the globe. F.
101. Supposed to be the marquis de Pau. F.
102. Lune en état de Guerre.
103. The stone employed by the inhabitants of Otahitee for

chissels and other tools, and even for ornaments to be hung in the
ears, is by all appearances a kind of lapis nephriticus, which when
transparent is pale-green, very soft, and employed for the latter
purpose; but when opaque, it is of a deeper hue and harder. In
South America the same kind of stone is employed by the natives for
ornaments; and is much valued among the Topayos, or Tapuyas, a
nation in the interior parts of Brasil, living along the river of that
name, which falls into the river of Amazons. This stone is called
tapuravas by the Galibis, a nation in Guiana; the Europeans settled
in these parts of the world, call it the Amazon’s-stone; the European
jewellers think it to be jade, a kind of precious stone of the same
colour brought from the east. It is said that stones of this kind are
found near the river St. Jago, forty miles from Quito, in the province
of las Esmeraldas, in Peru. They grow more and more scarce, being
much coveted by the nations of Guiana, the Tapuyas, and some
other Indian nations, and likewise frequently bought up by the
Europeans. Barrere Nouvelle Relation de la France equinoxiale, Paris
1743, and Condamine Relation abregée d’un Voyage fait en
descendant la Riviere des Amazones, Paris 1746. F.
104. Though our author has strongly pleaded in this paragraph in

behalf of Aotourou, it cannot, however, be denied that he was one of
the most stupid fellows; which not only has been found by
Englishmen who saw him at Paris, during his stay there, and whose
testimony would be decisive with the public, were I at liberty to
name them; but the very countrymen of Aotourou were, without
exception, all of the same opinion, that he had very moderate parts,
if any at all. F.
105. In the French theatre there is, in the door of each box, a
small window or hole, where people may peep through, which made
it possible to Aotourou to enjoy even in the galleries the sight of the
dancers. F.
106. Arbre du Grand Seigneur.
107. The contrary, of the last mentioned circumstance, has been

observed by our English navigators; and it is therefore highly
probable Mr. de B. picked up his vocabulary of words from Aotourou,
who had an impediment in his speech. F.
108. Pilotes-côtiers.
109. Pilote-pratique de la côte de France.
110. Pilotes, Aide-pilotes, ou Pilotins.
111. Aides-pilotes.
112. Valentyn and others say Heemskirk. See Dalrymple’s
Historical Collection of Voyages in the South Pacific Ocean, p. 83.
113. Tobia, the man who went away from Otahitee, on board the
Endeavour, according to the published Journal of a Voyage round the
World, gave our circumnavigators accounts of many more islands in
these seas, some of which were really found by our people; but
many more were known only from his narrative of an expedition of
these islanders to the west. As the number of these isles seems to
be so considerable, it would certainly deserve another expedition to
discover them all; and though at present the advantages seem to be
of no great consequence, which might be reaped from an
intercourse with these islanders; it is however certain, that the same
objection might have been made to the first discoverers of America;
and every body is at present sensible of the benefit accruing to
these kingdoms from its American settlements. F.
114. Enseigne de la Marine.
115. Cornets are a species of shell-fish. F.
116. Ouessant.
117. Raz (or rat, a race or whirlpool) is a place in the sea where
there is some rapid and dangerous current, or where there are
different tides. Such a rat is commonly to be met with in a strait or
channel, but sometimes likewise in the high seas. See the
Dictionnaire Militaire portatif, 12mo. 3 vols. 1758. Paris. F.
118. Enseigne de Vaisseau.
119. This bird is a native of the Isle of Banda, one of the

Moluccas, and is called by the Dutch Kroon-Vogel. Mr. Loten
presented one, some years ago, alive to the late princess royal of
England and of Orange. Mr. Brisson, in his Ornithology, vol. i. p. 279.
t. 26. f. 1. very improperly calls it a crowned Indian pheasant (Faisan
couronné des Indes); and Mr. Buffon, in his Planches Enluminées,

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Essential Concepts of Occupation for Occupational

Elements of Industrial Hazards Health Safety

Environment and Politics Routledge Introductions to

The Elements of Typographic Style 3rd Edition Robert

Elements of Chemical Reaction Engineering 3rd Edition

Diversity Mosaic Participant Workbook Developing

Essentials of Anatomy and Physiology 5th Edition Tina

Fundamentals of Machine Elements SI Version 3rd Edition

Chapter I-Philosophy, Science and Occupational Therapy I

Chapter II-Evaluation and Dynamic Systems . _ .. ······ ·-····23

Sensory Modulation-related Assessment Tools............................... ..... 71

Chapter III - Sensory Modulation and Intervention.. ·--········· · · ·····. 95

Chapter IV-Environmental Modifications and Program

Chapter VI-Resources ... 231

Chapter VII-Glossary and References , • ••m·•······•··•••·-·•········-·••••·· -· ·249

Chapter VIII-Sensory Modulation Worksheets ......... . 265

vi Sensory Modulation & Environment· Essential Elements of Occupation

Table and Figure List Vii

vUl Sensory Modulation & Environment: Essential Elements of Occupation

I Philosophy, Science and Occupational Therapy 3

Table 1: Comparison of Classical Science and Nonlinear Science

Classical Science Nonlinear Science

Meehanisti c/control-based Self-organizing

4 Sensory Modulation & Environment: Essential Elements of Occupation

Nonlinear Dynamic Systems, Chaos and Complexity Theories

I Philosophy, Science and Occupational Therapy 5

GAME THEORY SYNERGETICS

---- FAR-FR OM-EQUILIBRIUM

© J. Goldstein (2006); printed with permission.

6 Sensory Modulation & Environment: Essential Elements of Occupation

Intention, Meaning and Perception (IMP)

I Ph losophy, Science and Occupational Therapy 7

Table 2: Intention, Meaning and Perception (IMP)

I Intention Goal directedness emerging within and from the brain

largely resulting from sensorimotor experiences

The self-organization of sensorimotor information and meanings, through

Neuro-occupation and IMP

8 Sensory Modulation & Environment: Essential Elements of Occupation

Butterfly Effects: Sensitivity to Initial Conditions

I Philosophy. Science and Occupational Therapy 9

The "Edge of Chaos" and "Degrees of Freedom"

10 Sensory Modulation & Environment: Essential Elements of Occupation

Figure 2: The Circular Causality of Attractor Strengthening

t Philosophy, Science and Occupational Therapy 11

12 Sensory Modulation & Environment: Essential Elements of Occupation

Perturbation and Bifurcation

I Philosophy, Science and Occupational Therapy 13

The Stress Response and Homeodynamics

14 Sensory Modulation & Environment: Essential Elements of Occupation

Table 3: Parasympathetic Nervous System Branches

I Philosophy. Science and Occupational Therapy 15

16 Sensory Modulation & Environment: Essential Elements of Occupation

I Philosophy, Science and Occupational Therapy 17

18 Sensory Modulation & Environment: Essential Elements of Occupation

I Philosophy, Science and Occupational Therapy 19

Champagne, Ryan, Saccomando & Lazzarini (2007). Reprinted with permission.