Sensory Processing Disorder/Sensory Integration Problems

Remedial approach for SI treatment to be given til ___

8 years old

Adaptive approach for SI treatment to be switched to at ___

4th grade and up

Sensory discrimination disorder

difficulty discriminating subtle differences in any of the sensory systems

concerns for sensory discrimination disorder

• diff following instructions

• confuse sounds

• trouble spacing letters/words

• no finding hidden pics

• aversion to visual games

trouble spacing letters/words at 2nd grade

indicate visual spatial dysfunction

clinical signs for sensory discrimination disorder

• no differentiate b/w visual or auditory signals

• directions repeated

• more time to complete tasks

• trouble judging force/pressure

sensory based motor disorder

dysfunction occurs when tactile. prop, and vestibular senses that allow our bodies to move and sense postion are impaired

postural disorder (vestibular bilateral problems)

difficulty maintaining enough control of one’s body to meet the demands of given motor task

dyspraxia (praxis problems)

motor planning difficulties on

• ideation

• planning

• sequencing

• execution

senses affected for postural disorder

vestibular and proprioception

senses affected for dyspraxia

somatosensory

• proprioception

• tactile

Ideation , planning, and sequencing

Forming movement ideas not visible in CNS

Concerns for postural disorder

• slumps in chair

• Diff balancing

• Difficulty with gross motor play

• Poor pencil grasp

• Delayed hand dominance

• Trouble bilateral coordination

Evaluation for Postural disorder

• low m. Tone

• Poor bilateral coordination- UE and/or LE

• Poor balance

Praxis

Ability to conceptualize, plan, and execute a skilled non habitual motor act

concerns for dyspraxia

• diff leaning new motor skills

• Diff motor activities with more than 1 step

• Diff coming up with new ideas in play

• Clumsy

• Destructive in play

• Diff keeping personal space

Evaluation for dyspraxia

• emotionally reactive

• Clumsiness

• Attention deficits

• Sedentary or hyperactive

• Oral praxis

• Gravitational insecurity

OT sensory processing intervention is based on

OT-SI evaluation data

10 steps of Fidelity Checklist

1. Ensures physical safety

2. Presents sensory opportunities

3. Supports sensory modulation for attaining and maintaining a regulated state

4. Challenges postural, ocular, oral, and/or bilateral motor control

5. Challenges praxis and organization of behavior

6. Collaborates in activity choice

7. Tailors activity to present just right challenge

8. Ensures that activities are successful

9. Supports child’s intrinsic motivation to play

10. Establishes a therapeutic alliance with the child

Step 1

Ensure physical safety

• environment

• Therapist stand close to child, never leave them alone

Step 2- present sensory opportunities

Related to sensory strengths and needs, SENSORY RICH

• tactile

• Prop

• Vestibular

Step 3- sensory modulation for attaining and maintaining a regulated state

• OT modifies sensory conditions and activity challenges to help child attain optimal arousal, alertness, and affect enáguate ent in activities

• “Warm up”

• Sleepy- wake up

• Hyper- prop to clam down

Step 4- challenges postural, ocular, oral, and bilateral motor control

• vestibular proprioceptive activities

Step 5- challenges praxis and organization of behavior

• proprioceptive-tactile activities

• Challenge and supportchild’’s motor planning, ideation, and or ability to plan and engage in organized activities

Step 6- collaborates in activity choice

• share control with child, goal setting for intervention

• Help with set up

Step 7- tailor activity to present just right challenge

• help in adaptive response that help organize brain

• Activity grading

• Respond to child’s emotions and subtle behaviors

Step 8- ensure activity is successful

• activity grading

• Just-right challenge

Step 9- support child’s intrinsic motivation to play

• self goal-driven is more motivating

Step 10- establish therapeutic alliance with the child

• need strong relationship

• Working together

• Participate in activities

• Positive encouragements/reinforcements

Forearm alternating movements normative guidelines

2-4 movements in 10 sec

Forearm alternating movements Interpretation

• cerebellar integrity

  • Motor planning

  • Sequencing

  • Processing of somatosensory info

Sequential finger touching normative guidelines

• increase in hand functions between 3-6 years of age

Sequential finger touching Interpretation

• Cerebellar function

• Somatosensory processing

• Motor planning

Finger to nose test normative guidelines

• 5 yr old touch w/in 1 cm of tip of nose

• 7 yr old should not miss contact w/ either the nose or finger more than once

Finger to nose test Interpretation

• cerebellar integrity

• Somatosensory info

Automatic eye movements normative guidelines

• attained 2-6 mo.

Automatic eye movements interpretation

• visual, vestibular, proprioceptive functions

• Requires dynamic postural control

Consciously directed eye movements normative guidelines

• 5 yr olds

Consciously directed eye movements interpretation

• ocular control

• Ocular motor planning

• Vestibular proprioceptive processing

• Postural stability

Schilder’s Arm Extension Test normative guidelines

• 5 yr olds, 84% able to maintain arms in position

• Normal to rotate upper trunk and arms as much as 45 degrees toward side of head being rotated

Schilder’s Arm Extension Test Interpretation

• cerebellar integrity

• Vestibular proprioceptive processing

Antigravity Flexion and supine flexion interpretation

• somatosensory processing

• Tactile and proprioceptive discrimination

• Motor planning

Antigravity extension an prone extension

-8 year olds able to hold for 30 sec

Antigravity extension an prone extension Interpretation

• vestibular proprioceptive processing

• Motor planning

Postural control interpretation

• visual, vestibular, and proprioceptive input

Protective extension normative guideline

1 yr of age fully developed

Protective extension interpretation

• vestibular processing

Weight bearing and proximal joint stability normative guideline

1st year of age

Weight bearing and proximal joint stability interpretation

• vestibular and proprioceptive processing

• Muscle tone

gravitational insecurity interpretation

modulation of vestibular, proprioceptive, and visual information

projected action sequences interpretation 

• vestibular proprioceptive processing

• motor planning

Bilateral motor coordiantion interpretation

• vestibular and proprioceptive deficits

reactions to sensations interpretation

• vestibular proprioceptive sensations

free play and play preferences interpretation

• childs intrinsic motivation

• ideation

• motor planning

• sensory preference

praxis interpretation

• tactile, proprioceptive, and vestibular processing

target population for SPM2

4 mo to 87 yr

theoretical framework for SPM2

ayres senosry integration

Target population for BOT3

4-25 yrs

Covers school-age range served under IDEA

Focus of OT in BOT 3

Fine motor composite

• fine motor control

  • Precision and integration

• Manuel coordination

  • Manuel dexterity and UL coordination

Time for brief form of BOT 3

20-25 min

Time for Complete form

60-90 min

Time for Fine motor part

30-45 min

Time for Gross motor part

30-45 min

Do not begin the BOT 3 exam unless ____ needs are met

Physical needs (thirst, hunger, restroom)

BOT 3 provides a quick overview of ______

Motor performance

When conducting the bot 3 do ____ items first and then ____ items last

Fine, gross

How do you determine hand and foot preference

• pick up pencil on table

• Throw tennis ball on table

• Kick tennis ball on floor