Sensory Integration Assessment - Term Paper Example

Sensory Integration Assessment Report ASSESSMENT TOOLS: Beery Developmental Test of Visual Motor Integration, fifth edition (VMI): The experiment to assess visual motor assimilation: Visual Motor Abilities (Visual Sensitivity and Motor Synchronization): A subject is evaluated on visual motor abilities from the extent of synchronization of its hands with the eyes in the course of different accomplishments. The difficulties in reaching (tend to tumble) and holding (tend to fall) objects will indicate discrepancies in visual motor coordination. Subtest Raw Score Standard Score Percentile Visual Perception 27 110 75% Motor Coordination 23 90 25% VMI 20 85 16% Visual motor integration was determined by Beery-Buktenica Developmental Test. The visual motor abilities of the child were measured from three experiments namely, Visual Perception, Motor coordination, and Beery-VMI. The skill of acquiring and reading visual stimuli perceived from the surroundings is known as visual perception. Visual perception skills considered are visual discernment, remembrances, position in the space, structural permanence, object field, and visual closure. In a given trial, the skill of synchronizing actions of different body organs in the space is called Motor coordination. This child shows deficiency in incorporating visual perception and/or motor coordination abilities as obvious from the VMI values. This child demonstrated difficulties with regard to visual motor assimilation as indicated by the three experiments. The percentile score of this child was 75%, 25% and 16% for Visual perception, Motor Coordination and VMI respectively when compared with that of the children of the same age which was 100% on the average. This child scored only 16% for VMI which is very low. The major difficulty for this child is the deficiency in VMI which in turn will affect the handwriting and other jobs which involve the coordination of hands and eyes. This child will require extra time for the completion of homework to compensate the said deficiency. This child shows visual perception and /or motor coordination abilities but still require practice to assimilate the two areas. If not, it may show visual and /or motor deficiency. Short Sensory Profile: The Short Sensory Profile Test determines the “sensory modulation disorders” (Bundy, Lane, & Murray, 2002, p. 8). Sensory processing is the major field which is usually used for evaluation because it represents the core concept compared to just modulations. The deficiency in sensory modulations is assessed from the responses of the object to a sensory stimulus demonstrating deviations from normal. The Short Sensory Profile Test results are as under: Raw Typical Probable Definite Sensory Processing System Score Performance Difference Difference Tactile Sensitivity 22/35 X Taste/Smell Sensitivity 4/20 X Movement Sensitivity 11 /15 X Underresponsive/Seeks Sensation 17/35 X Auditory Filtering 18/30 X Low Energy/Weak 12/30 X Visual/Auditory Sensitivity 12/25 X Total 96/190 X Thus the Short Sensory Profile Test demonstrated a definite difference in all the response categories investigated except “movement sensitivity” response where it demonstrated a probable difference. Tactile System: The tactile system discerns the outside stimuli with the help of receptors present in the skin. It discriminates different tactile stimuli. The effect of light touch is fast, diffused and dispersing and warns the nervous system of expected danger. Pressure touch slows down the nervous system. Its sensation is localized and discerns different shapes, textures, and sizes just from touch stimuli. The learning process is also enhanced by the tactile system. Any deficiency in this system will result in learning problems. The clinical observations indicate that this child is deficient in tactile system. He may not detect stimuli or may show indifference to stimuli or give a late response to stimuli. He may face difficulty in detecting the position and/or time of tactile stimuli. Vestibular System: The receptors of the vestibular system are located in the inner ear which discerns the movements of the head and in turn it manages the position, equilibrium and other actions throughout life of the individual. It controls the position and movements of head through action on the muscles. It affects posture and movement because it has an influence on muscle tone. This system prepares us to counter the gravity reaction while we are moving, running or jumping. We know our position in the space all the time due to this system. The results of the present clinical experiments indicate that the child showed a low response to vestibular stimuli. The child did not show any difficulty in detecting, recognizing and responding promptly to stimuli which was obvious from his average score and performance. The main areas of concern for this child are poor maintenance of posture, balance, equilibrium and /or head control and spine flexion. Proprioceptive System: The proprioceptive system denotes the “sensations of movements” e. g. “speed, rate, arrangement, timing, and force” (Bundy, Lane, & Murray, 2002, p. 85). It tells us the position of all the organs of our body and their movement. Its receptors are present in the muscles, tendons and joints. Sensory information travels through this system to the brain and from the brain to the muscles that contract which is indicated by stretching and bending. In this way, the brain knows all the times the position and activities of all the organs of our body without the help of eyes. The present clinical experiment shows that the child is deficient in proprioception and demonstrates it by colliding with objects, repeating or by falling down. Auditory System: The sound and its direction can be discerned by auditory system. The sound waves move in the form of action potential within the inner ear after passing through the external ear and middle ear. We can listen the speech and understand it to perform different function with the help of this system. We can also respond to a noise by turning our head toward the sound to save ourself from any danger. The present clinical experiment shows that the child is facing auditory sensitivity. The child may face difficulties in acting upon instructions, disorganized and derailed in noisy places. He may express intermittent attention indifference and sensitivity to high sounds (Bundy, Lane, & Murray, 2002, p. 143). The auditory system also helps in controlling movement and thus deficiency in this system affects body movements and balance. Visual System: We can distinguish between forms, colors, alphabets, words and numbers. The body language expressed during social interaction can only be understood with the help of visual system. We can move freely in this populated world, evaluate the speed of different objects and our own, measure how distant different objects are from each other and, recognize different types of things around us and our friends and enemies. The present clinical experiment shows that this child expressed visual sensitivity. He may be disturbed by illuminations, may face difficulty in finding objects in matched environments, and may confront problems in assessing positions and postures of different articles in the environment. Sensory Modulation: The sensory modulation deficiency was expressed by this child as indicated by clinical experiments in the areas of tactile, proprioceptive, vestibular, and auditory systems. This argument was further strengthened by parent report and child report. An individual faces problems in regulating or controlling his reactions to sensory stimuli due to sensory modulation deficiency. This child could not sustain a principal series of activities to meet different life tasks. The child possessed underresponsive vestibular and proprioceptive systems due to which he showed deficiency in managing vestibular, proprioceptive, and tactile stimuli. This child may show signs like these: difficult for him to wait for his turn, interferes regularly, cannot keep quiet when there is a need for it, remains tense with severe attitude, may prove dangerous for others and very friendly. Such a child is called sensory under responsive (SUR). Sensory under responsiveness (SUR) is a child that is either ignorant of sensory input or show low sensitivity with regard to others. This child look: inactive, silent, reserved, avoid dialogue, living in imaginary world, express indifference and tired, very weak responses to instruction, very feeble exploratory behavior towards his surroundings. Postural Control: It is difficult for this child to control his posture due to deficiency in visual, proprioceptive, and vestibular systems. The performance of the child at any moment depends upon the feedback from these systems. As a result the child will face problems foreseeing actions i.e. running for catching a ball. He will have problems with the balance due to deficiency in pose regulation. The upper extremities and trunk of this child is usually weak and it is difficult for him to sustain backbone flexion. He may also dislike exercises like pushups or sit-ups during tests. Clinical Observations of Motor & Postural Skills: COMPS Scoring Sheet: This experiment evaluates Developmental Coordination Disorders (DCD) and/or Sensory Based Dyspraxia. A person is evaluated for his coordination abilities during trials. An individual is assessed for motor planning and its synchronization with sensory functions. This child was evaluated on his coordination abilities, performing six experiments: 1) Slow Movements 2) Rapid Forearm Rotation Finger 3) Nose Touching 4) Prone Extension 5) Asymmetrical Tonic Neck Reflex (ATNR), and 6) Supine Flexion The results of the COMPS test are as under: Slow Movements Outward Inward Symmetry 1/2 2/2 symmetrical, some asymmetry, completely asymmetrical Quality of Performance 2/2 2/2 smooth, some irregularity, jerky Speed 1/2 1/2 5 or more seconds, 3 or more seconds, 0 to 2 seconds Total: 9/12 This experiment evaluated child on the aptitude to accomplish gentle, smooth, symmetrical movements that are regulated in speed as well as strength. This test shows that this child proved decent symmetry of inward movements, decent class of performance of even movements. However, the speed remained very slow during these movements. Generally, he established reasonable motor control with a rating scale of 12. Rapid Forearm Rotation Number of Rotations R 10 Number of Rotations L 9 Number of Rotations Both 7 9 or more rotations in 10 seconds 4-8 rotations in 10 seconds 1-3 rotations in 10 seconds Unable to complete task Rating Scale: R L Both 4 4 3 Total: 11/12 This experiment evaluated the child with respect to his skill in carrying out fast left and right arm movements to check his motor control and position consistency. He showed good motor control for fast alternating right and left forearm rotation movements and secured a total score of 11/12. Finger Nose Touching R Eyes Open R Eyes Closed L Eyes Open L Eyes Closed Moving Arm 2/3 1/3 2/3 1/3 (smooth, direct, irregular, unable) Extended Arm 1/3 1/3 1/3 1/3 (completely extended, 30 elbow flexion) Force of Touch 1/3 1/3 1/3 1/3 (light touch, 3 times pushing) Missed Contact 1/3 1/3 1/3 1/3 (0-1 missed nose or finger, 2missed both nose & finger) Total: 4/12 This experiment evaluated the child for his capability to synchronize movements. It is beneficial in distinguishing between children with or without motor difficulties. The child was assessed for the skill to collect sensory signals, movement scheme, accuracy in objective movements, and steady pose maintenance at both ends with a projected arm. This child revealed plane and straight movements of arm, reduced extension of arm, reduced strength of touch, reduced connection. The experiment indicates that this child has problem in sustaining the location of his arm and his pose throughout the movements. Child has difficulty in proprioceptive response. This outcome is in agreement with other children with motor problems as they depend more on visual evidence than on proprioceptive response. Prone Extension a. Assumes 1/2 body parts segmentally b. Head 1/2 face looking at mat or slightly forward with neck extended 90 f. Maintains (based on 15 seconds) 0/2 does not assume or maintain Quality Score: 1/3 Duration Score: 0/3 Total Quality Score: 3/12 This experiment evaluated the child for his aptitude to achieve and sustain stimulant postural extension to counter the gravitational force. This child proved reduced inclined extension movements. This experiment shows that the child is perhaps suffering from a postural-ocular movement disease. He faces difficulties in carrying out standing jobs such as sustaining an standing position and correct head posture in sitting position. He may also demonstrate difficulties in sustaining positional consistency during movements. ATNR Elbow Flexion (0-30 degrees) R 3/3 L 3/3 L 3/3 R 3/3 R 3/3 L 3/3 L 3/3 R 3/3 Right + Left = 24 divided by 2 = Total: 12/12 Total head to the left (right arm scores) 12 Total head to the right (left arm scores) 12 Total: 12/12 This experiment evaluated the child in CNS immaturity i.e. retaining preceding reflex beyond 300 of flexion. In extreme case the child cannot assume a tetrapod posture without fixing some joints or locking elbows indicating least positional steadiness. This experiment shows the ability of the child to sustain a bilateral coordination during performance of different jobs. The score of this child i.e. 12/12 show that he possessed an excellent ATNR reflex during elbow flexion movements. Supine Flexion a. Assumes 1/2 body parts segmentally b. Neck 1/2 chin protrudes with neck extended Read More