Evaluation for specific problems in sensory integration
should be done as part of the comprehensive assessment of the child.
Generally, occupational therapists use a "top down" approach:
the first questions asked concern the child's roles and routines
(what is done, what is expected to be done, what the child wants
to do) and what specific problems bring the child to the occupational
therapist. Previously gathered information and evaluations should
be carefully read in order to understand the child as holistically
as possible. These are the questions that I ask myself during the
- What are the problems perceived by the child and
the family that bring them to an occupational therapist?
- What information do we already have that contributes
to understanding the needs of the child and family?
- What new information is needed to clarify level
of function and to select the appropriate intervention strategies?
Is it reasonable and logical to think that poor sensory integration
is a significant contributor to the presenting problems?
- If I decide that I should explore the child's sensory
integration functions, I then proceed to select tests and tools.
When I assess a child, I try to follow the World Health
Organization (WHO) model for function. This allows me to examine
different levels of function.
I usually start at the Participation Level:
What is happening in the child and the family's life? How does the
child behave in his or her role as a child/family member; does the
child go to school/day care? Does the child have friends or belong
to play/community groups? What are the child and the family's dreams
and goals? What is happening that supports or constrains community
participation? What needs to happen to support function and participation?
This information can be gained by informal family interview; there
are several standardized measures (test development follows a specific
procedures; administration, scoring, and interpretation follow specific
guidelines) available to professionals. I have used the Canadian
Occupational Performance Measure (Canadian Occupational Therapy
Publications ACE, Ottawa, Ontario) and the School Function Assessment
(PsychCorp) to guide me at this level. This allows collaborative
goal-setting with the child and the family. It ensures that therapy
is meeting the functional needs of the child and the family: Being
able to tolerate swinging in a hammock for five minutes doesn't
have much "life value." Being able to ride in a car, on
an elevator, etc. will make living easier, more enjoyable, and allow
the child to access everyday tasks and opportunities.
After I know "where I want to go" (what
are the expected outcomes from intervention), I determine the "base
line" of function: knowing what the child is doing now allows
me to measure change in behavior/performance/function at intervals
during therapy. Therefore, I can alter strategies as needed and
demonstrate the effectiveness (positive change) of treatment.
The next step is to evaluate sensory integration processes.
The Sensory Integration and Praxis Tests (SIPT) (Ayres, 1989,
1991) is an instrument standardized for use with children 4 to 8.11
years old, who have relatively typical neuromotor, cognitive, and
attentional abilities. There are formal training programs for its
administration and interpretation. It attempts to measure component
levels (simple sensory processing that are contribute to function)
of the tactile, kinesthetic (awareness of body position and movement
in space based upon proprioception), and vestibular systems, as
well as tasks associated with visual perception and praxis (motor
planning). Another example of the term "component" might
be helpful: eye movements following rotation (post rotary nystagmus)
measure vestibular function at a component level; ability to hold
extension patterns (holding limbs straight when lying on the stomach)
measures vestibular function at a task level. A list of the tests
with a brief description of each is located in the digital library
developed for this unit.
Obviously, the SIPT is not appropriate for many children
suspected of having sensory integration problems (note age, type
of child used in the standardization procedures). Therapists may
also use formal and informal Clinical Observations for identifying
behaviors associated with DSI. Please note Table 1. Observation
of these tasks provides insight as to level of function and sensory
processing necessary for successful performance. The work of Erna
Imperator Blanche (Observations Based on Sensory Integration)
provides a two-part video and worksheet for a nonstandardized assessment.
It is available in several sources provided at the end of this unit.
Parents should know that the tasks and behaviors associated with
clinical observations are age-related (that means that young children
may be unable to perform them) and difficult to standardize (many
have attempted to do so). Used knowledgeably, they can provide important
information about quality of performance, influence of sensory processing,
and constraints to function.
Examples of Clinical Observations
Besides direct observation of a child's performance
(performance-based assessment), use of questionnaires and histories
(judgment-based assessment) are critical to diagnosing a dysfunction
in sensory integration. There are two major reasons for this: (1)
The SIPT does NOT evaluate sensory modulation dysfunction (e.g.,
Tactile Defensiveness). (2) Children perform most typically in their
natural environments (home, school, etc.) rather than in the contrived
clinical experiences that often use a "performance-on-command"
(e.g., Hop on one foot 10 times) paradigm. The Sensory Profile
(W. Dunn,), a standardized questionnaire with several age levels,
is used by many therapists. My personal choice for such a tool is
the Evaluation of Sensory Processing (ESP) by L. Diane Parham.
The research edition is available to therapists in text Sensory
Integration Theory and Practice (Bundy, Lane, & Murray).
I often use clinical observations of performance made
during standardized tests such as the Bruininks-Oseretsky Test of
Motor Proficiency, the Peabody Motor Scales Revised, the Movement
ABC, and the Beery Test of Visual Motor Integration. These observations
should support parent reports, other standardized and nonstandardized
measurements, and observed functional behavior.
I would like close the assessment and evaluation section
with the following thoughts. In my view, a dysfunction means there
is a negative impact on function: the presence of certain behaviors
associated with DSI are not meaningful to me unless they interfere
with activity and participation AND unless I think that I can change
them. Assessment is an important part of intervention: it tells
me where I was, what I am doing (I may have modify), where I would
like to go, and if I got there. The purpose of this information
is to assist the family and child to be knowledgeable consumers.
It is the knowledge and opinions of the writer and is not meant
to replace direct service from an occupational therapist.