Sensory Integration: Frames of Reference, Observation, and Telehealth (Lab Session Notes)

Context and introduction

• Opening tone: reflections on feelings and experiences from the world, care and grace in supporting children and families; gratitude for time together; focus, learning, and connection; recognizing we are not alone in this work.
• Prayerful/ethical framing: bless our hands, eyes, and minds; patience with ourselves and others; emphasize work as part of something larger bringing comfort, support, and hope; space for respect, growth, and compassion for all.
• Course framing: final session on sensory integration and sensory processing frames of reference; these population classes (mental health, adults, children) can be lengthy; this course aims to prepare you for entry-level work and ongoing skill development after this course.
• Adjuncts and practice settings: many adjuncts are in private or home-based practice; opportunity to learn how they entered their fields and specialties.
• Certification and education: discussion of further certification/education related to frames of reference; fieldwork can support these learning goals depending on the setting.
• School-based practice context: in schools, clinicians primarily use sensory-based strategies as part of education, not only immersive SI models; targets and approaches differ by setting.
• Literature note: last week’s literature included some statistical analyses of sensory profile types; this week continues with related sensory questionnaires used in the upcoming lab activity; you will review these in person next week.
• Class logistics: poll format shift to Zoom; 10-question participation activity in a two-truths-and-a-lie framework; designed to prompt recall and discussion about the article’s population, setting, and takeaways; emphasis on casual collegial discussion about relevance to practice.
• Technical challenges mentioned: occasional poll disappearance; reminders to manage multiple tabs; general problem-solving mindset when technical issues arise.
• Observational data workflow: we will view a live, copyrighted SI observation video by Dr. Erna Blanche (sensory integration researcher) who demonstrates a comparative observation of two children in a clinic setting; no formal diagnosis given; focus on functional performance and observation-based data collection.
• Worksheet and data collection: accompanying worksheet is a data-collection tool with columns for notes, checks, and multiple observations; there is no single “right answer”; the worksheet organizes your thinking during observation and helps with note-taking and later analysis.
• Data types distinction: standardized scores vs. observational data; standardized assessments provide a benchmark relative to typical development, whereas observational data (clinical skill, nuance, and qualitative information) informs interpretation and planning, and remains essential for practice.
• Early child assessment approach: start with observation, arousal level, postural control, organization of behavior, and motor planning as the child transitions into the observation setting; the assessment sequence can be flexible and is guided by the child’s lead.
• Terminology and framework: reinforcement of key SI concepts such as praxis (motor planning), feed-forward vs. feedback, and vestibular, proprioceptive, and tactile processing; emphasis on linking sensory processing to functional tasks and activity selection.
• Fieldwork planning: two first lab days emphasize standardized vs observational approaches and the use of observations within fieldwork to inform OT goals, activity selection, and family engagement.

Frames of reference and practical application in settings

• Sensory integration as a frame of reference informs how we organize and interpret sensorimotor information for functional performance, particularly around movement, posture, and motor planning.
• In school settings, SI-based activities are integrated with educational targets; emphasis on how sensory processing supports learning and participation in classroom routines.
• In private practice or home-based settings, there is often more flexibility for immersive SI activities or a broader set of sensory-based strategies tailored to family routines and home environments.
• Work toward effective interprofessional communication: translating clinical SI observations into language understandable to families and to other professionals; bridging neurological framing and everyday function.
• Use of analogies and visuals: common experiences (e.g., beach visualization) help clients and families relate to sensory experiences and self-regulation.

Article and measurement literacy

• This week’s article review focuses on sensory profiles and-related questionnaires used in SI research; plan to review additional questionnaires in lab tomorrow as you observe and compare.
• Lab activity is designed as a practical, hands-on exploration of how standardized and observational data complement one another in forming a clinical picture.
• Emphasis on being able to explain to colleagues what the article studied, the population, setting, and key takeaways; the classroom activity encourages discussing relevance to practice in a casual, relatable way.

Observation and data collection: the SI observation video and worksheet

• The video follows Dr. Erna Blanche and demonstrates an observational assessment of two children (no diagnosis given) in a sensory integration clinic; focus on functional performance in movement activities and how to observe without relying solely on standardized tests.
• The accompanying worksheet is used to structure observations: some cells may be blank, some checked, some commented; it is a flexible tool for organizing clinical impressions.
• Key data collection steps emphasized in the video:
  • Arrival observations: arousal level, postural control, organization of behavior, motor planning during transition to the observation setting.
  • Forearm alternating movements: copies examiner’s rapid, repetitive forearm rotation; indicative of cerebellar function and motor planning/processing of somatosensory input; typical performance is 2–4 movements in 10 seconds.
  • Sequential finger touching: sequentially opposition of thumb to all fingers; testing both hands for differences; assesses independent finger movements, coordination, timing, and sequencing.
  • Finger-to-nose: accuracy and smoothness of bringing extended finger to nose without somatosensory input; typical five-year-olds touch within 1 cm of the nose tip; checks self-correction and proprioceptive feedback.
  • Eye movements and tracking: target fixation and tracking with head movement; observe stable visual field, eye-head coordination, and smooth pursuit.
  • Shoulders/arm extension test and anti-gravity flexion: maintain arm position with eyes closed; apply gentle head movement to assess how arms stabilize trunk; evaluate proprioceptive and cerebellar involvement; assess symmetry between right and left.
  • Supine and prone positions against gravity: observe flexion/extension patterns, time to maintain positions, and quality of movement; these relate to tactile, proprioceptive discrimination and vestibular processing.
  • Dynamic postural control and reactions: reactive and anticipatory postural control; forward protective reactions; weight bearing and proximal stability; use of a ball to test gravitational insecurity and responses to perturbation.
  • Bilateral motor coordination and projected action sequences: swinging, catching, skipping, jumping jacks; assess vestibular processing, anticipatory postural control, and feed-forward planning.
  • Tactile play: explore tactile discrimination and modulation with eyes open and closed; assess tactile defensiveness or hypersensitivity as part of modulation.
  • Client choice and play preferences: observe ideation, intrinsic motivation, and motor/social skills as the child selects activities (e.g., roller racer vs. construction play); use of child-led activity to gather information while remaining therapist-supported.
• Practical takeaways from the worksheet:
  • There is no single “right” observation; different children may yield different applicable observations depending on interest, engagement, age, and setting.
  • You can incorporate observation into warm-up activities (e.g., coloring a picture of Pokemon) to build rapport while collecting useful postural or motor data.
  • Observations can be integrated into occupational profile development; the child contributes in their own way, which informs goals and collaboration with families.

Specific observational tasks and what they measure

• Forearm alternating movement (rapid forearm rotation):
  • Tests cerebellum function; indicators of motor planning, sequencing, and somatosensory processing.
  • Typical performance: 2–4 rotations in 10 seconds; observe fluidity and coordination of supination/pronation.
• Sequential finger touching:
  • Observes finger-thumb opposition and finger isolation; checks bilateral performance for asymmetries; looks at timing and sequencing.
• Finger-to-nose:
  • Proprioceptive accuracy without visual guidance; checks self-correction and motor planning/coordination.
• Eye movements and tracking:
  • Visual tracking ability; stability of gaze while head moves; assesses vestibular-ocular integration.
• Shoulder/arm extension and anti-gravity control:
  • Proprioceptive and vestibular contributions to maintaining arm position with eyes closed; checks bilateral symmetry and motor control against gravity.
• Supine and prone flexion against gravity:
  • Observes the ability to extend against gravity; relates to vestibular function and proprioception; older children can show resistance to weight-bearing.
• Dynamic postural control and protective reactions:
  • Tests how the child stabilizes the body in response to external or self-initiated movement; resilience to perturbation.
• Gravitational insecurity assessment via ball-tilt:
  • Observes anxiety or discomfort with feet off ground; indicators of vestibular and proprioceptive processing; posture adjustments on a moving ball.
• Projected action sequences and bilateral coordination:
  • Observes planning and execution of a movement goal; uses swing and catch tasks to assess vestibular input, anticipatory control, and body awareness.
• Tactile play and discrimination:
  • Examines tactile discrimination and modulation (tactile defensiveness or hypersensitivity) through guided tactile experiences with/without vision.
• Play preferences and ideation during activity choice:
  • Provides information about intrinsic motivation, sensory needs, and motor/social skills; informs task selection and engagement strategies.
• Therapeutic approach: therapist-led vs child-led observation
  • Therapist-directed tasks can still yield information about the child’s capabilities while guiding engagement; child-led choices reveal input, preferences, and natural performance patterns.

Just Right Challenge (JRC) and activity analysis

• Just Right Challenge concept:
  • An activity that matches the child’s current abilities and allows for growth with a feasible level of challenge; not too easy, not too difficult.
  • Grading up or down based on ongoing observation and activity analysis to optimize participation and learning.
• Activity analysis steps for JRC:
  • Break down the activity into components (e.g., hopscotch: balance, single-leg stance, jumping, sequencing, visual tracking).
  • Identify which components are too easy or too hard and adjust (e.g., balance on one leg, alternate stepping, or support from the parent/therapist as needed).
  • Consider alternate activities that target the same skills if necessary (e.g., Candyland with balance tasks between turns).
  • Ensure the child is engaged and participating; the rubric should capture process and preparation, not just success.
• Practical tips for fieldwork and telehealth:
  • Use activity substitutions or “on-the-fly” grading to adapt to the child’s environment and available equipment.
  • If the child relies on caregiver support during a balancing task, gradually reduce support as the child demonstrates tolerance and skill; emphasize the child’s own balance sensations.
  • Use meaningful, familiar play (e.g., hopscotch, Candyland) to increase engagement while challenging motor planning and balance components.
• Example of on-the-fly grading from a telehealth session:
  • A clinician demonstrates adjustments to a hopscotch task via telepractice; the adjustments aim to move from supported balance to independent balance as tolerated.
  • The clinician emphasizes breaking the activity into smaller components (standing on one leg, balancing in place) and building up to the full hopscotch task.

Telehealth planning and fieldwork considerations

• Telehealth planning principles:
  • Do not assume anything is true; plan for variability in home environments and caregiver involvement.
  • Prepare activities that can be performed with minimal equipment and with caregiver support when needed.
  • Consider how to score or document participation and progress when some tasks may be adapted or abbreviated due to setting constraints.
• Angelica’s case (planning hopscotch for balance):
  • She asked whether caregiver assistance for balance would affect grading according to rubric; the instructor approved of considering just-right-challenge adjustments and activity analysis to determine level of support and progression.
  • Suggestions included analyzing hopscotch components (balance, weight shift, proprioception) and identifying points to scale difficulty up or down, as well as using alternative games (e.g., Candyland) to facilitate engagement and grading.
• Ethical and practical implications in telehealth:
  • Respect family routines and cultural contexts; select activities that are feasible in the home and consistent with the child’s interests.
  • Provide clear instructions and safety guidelines for remote activities; ensure caregiver understanding and consent for intervention tasks.

Therapeutic communication and professional development

• Communicating with colleagues and families:
  • Explain sensory processing concepts in lay language and connect them to observable function and daily routines.
  • Translate clinical observations into actionable goals for the family and school teams.
• Professional collaboration:
  • Use the occupational profile to capture the child’s routines, interests, and family priorities; involve the child in the process as appropriate for age.
  • Recognize that feedback from families on activities like hopscotch and balance tasks informs goal setting and home-based practice.

Standardized vs observational assessments in SI practice

• Standardized assessments:
  • Provide a benchmark against age-typical development; used to determine the child’s relative standing.
  • Begin at the appropriate starting point and proceed through tasks; the “beginning” point may vary by age and development.
• Observational assessments:
  • Emphasize real-world performance, motor learning, and context-specific skills; useful for fieldwork, clinics, and early intervention planning.
  • Include qualitative information such as postural control, arousal, self-regulation, and engagement with activities.
• Integration of data:
  • Observations inform which standardized tests to administer and how to interpret scores in light of the child’s environment and goals.
  • Both data types support forming the occupational therapy plan and communicating with families and other professionals.

Practical implications and clinical reasoning

• Praxis and motor planning:
  • The ability to formulate, organize, and execute a plan of action for new tasks; linked to vestibular and proprioceptive input integration.
• Sensory modalities: vestibular, proprioceptive, tactile processing
  • Vestibular input influences balance, movement coordination, and anticipatory postural control.
  • Proprioceptive input informs body awareness, joint stability, and muscle recruitment strategies.
  • Tactile processing affects discrimination, modulation, and responses to touch; important for task engagement and boundary setting in activity participation.
• Gravitational insecurity:
  • Anxiety or apprehension when feet are off the ground; potential indicator of vestibular or proprioceptive processing differences.
• Weight bearing and proximal stability:
  • Proximal joint stability in the shoulder girdle and neck area is linked to vestibular and proprioceptive processing; poor stability can affect functional tasks.

Notable considerations, challenges, and takeaways

• Flexibility in assessment: clinical observation should adapt to child, setting, and available equipment; not every observation will follow a single sequence.
• The value of play in assessment and intervention: play is a meaningful context to observe motor planning, postural control, and sensory processing while building rapport.
• The importance of activity selection and just-right challenge: carefully calibrate tasks to optimize engagement, progress, and functional relevance.
• Ethical practice and communication: maintain empathy, respect, and family involvement; adapt to telehealth constraints while ensuring safety and privacy.
• Continuous learning: fieldwork and ongoing certification/education in SI perspectives and related frames of reference support ongoing professional development and competency.

Summary prompts and potential discussion questions

• How would you describe an SI-based observation to a colleague in a casual setting? What are the key “bones” of the observation to share?
• In what ways can you adapt a play-based activity to create a just-right challenge for a child with balance challenges?
• How does telehealth influence your approach to assessment, observation, and family collaboration in SI practice?
• What signs would indicate gravitational insecurity or proprioceptive processing differences during a session?
• How can you integrate occupational profile data with the results of observation and standardized tests to form a cohesive intervention plan?