The Sensory Integration and Praxis Tests (SIPT) help us to understand why some children have difficulty learning or behaving as we may expect. The SIPT do not measure intelligence in the usual sense of the word, but they do evaluate some important abilities needed to get along in the world. They do not measure language development, academic achievement, or social behavior, but they assess certain aspects of sensory processing or perception that are related to those functions. They also evaluate praxis or the child’s ability to cope with the tangible, physical, two- and three-dimensional world. Sensory integration is that neurological process by which sensations (such as from the skin, eyes, joints, gravity, and movement sensory receptors) are organized for use. Praxis is that ability by which we figure out how to use our hands and body in skilled tasks like playing with toys, using a pencil or fork, building a structure, straightening up a room, or engaging in many occupations. Practic ability includes knowing what to do as well as how to do it. Practic skill is one of the essential aptitudes that enables us “to do” in the world. “Dys” means “difficult” or “disordered”. Sensory integrative dysfunction may result in difficulty with visual perception tasks or inefficiency in the interpretation of sensations from the body. A dyspraxic child has difficulty using his or her body, including relating to some objects in the environment. A dyspraxic child often has trouble with simply organizing his or her own behavior. There are 17 SIPT tests. They fall, roughly, into four overlapping types: (1) motor-free visual perception, (2) somatosensory, (3) praxis, and (4) sensorimotor.
These tests evaluate the ability to visually perceive and discriminate form and space without involving motor coordination. The Space Visualization is a puzzle-like test in which the child indicates which of two forms will fit a formboard. Although the child is invited to place the form in the hollow of the formboard, the motor aspect of the test does not enter into scoring the test. The examiner does keep track of whether the child used the right or left hand in picking up the blocks and, in doing so, whether he or she crossed the body’s midline or tended to use each hand on its own side of the body. In the Figure-Ground Perception, the child points to pictures that are hidden among other pictures. The test measures how well a child visually perceives a figure against a confusing background.
These tests assess tactile, muscle, and joint perception. (“Soma” means “body.”) During somatosensory testing the child is encouraged to “feel” rather than “see.” A large piece of cardboard held over the area where the arms and hands are working helps the child concentrate on what is felt. Being touched where the child cannot see the touching often makes the child feel uncomfortable even though none of the tactile stimuli really hurt the child. If the child’s negative reaction to the testing is strong, the response is referred to as “tactile defensiveness.” On the Manual Form Perception, the child identifies through the tactile and kinesthetic senses unusual shapes held in the hand. On the Kinesthesia, the conscious sense of joint position and movement is evaluated by the child’s attempt to put his or her finger at the same place the therapist had previously put it. Tactile perception is measured with three tests: a) the Finger Identification, in which the child points to his or her finger that the therapist touched; b) the Graphesthesia, in which the child draws with a finger the same simple design the therapist drew on the back of the child’s hand; and c) the Localization of Tactile Stimuli, in which the child points to the spot where the therapist had lightly touched the child’s arm or hand with a pen. This last test leaves 14 tiny, washable spots on the child’s arm and hand.
Practic skill is evaluated six different ways: a) Praxis on Verbal Command assesses the ability to interpret verbally given instructions to assume certain positions and to then assume them. A typical test item might be “Put your hands on top of your head.” b) Design Copying evaluates the ability to copy simple designs. c) Constructional Praxis evaluates the child’s ability to build with blocks, using structures built by the therapist as models. Both the Design Copying and the Constructional Praxis require visual form and space perception, in addition to practic abilities. d) Postural Praxis requires the child to imitate the unusual body postures assumed by the therapist. e) Oral Praxis asks the child to imitate movements and positions of the tongue, lips, and jaw. f) Sequencing Praxis asks the child to imitate a series of simple arm and hand positions.
Four sensorimotor tests are included in the SIPT because their tasks require sensory integration. Bilateral Motor Coordination evaluates the ability to coordinate the two sides of the body in a series of arm movements. Standing and Walking Balance assesses the degree of sensory integration of the proprioceptive (muscle and joint) and vestibular (gravity and head movement) senses. On the Motor Accuracy, eye-hand coordination is measured by how well a child draws a line on top of a printed line. Executing the task requires eye muscle control, practic ability, visual perception, and motor coordination. Finally, the Postrotary Nystagmus measures the duration of the reflexive back and forth eye movements following rotation of the body (10 times in 20 seconds). This observation is one way of telling how well the nervous system is integrating the sensations from the vestibular system.
12 Signs of Sensory Processing Disorder
Feeding therapy is a specialized branch of occupational therapy involving specifically targeted treatments to address drooling, gagging, vomiting, decreased food/texture tolerance, and decreased strength or range of motion of the mouth and other facial structures. When a child has difficulty eating, it can affect all members of the family. Noble Therapy offers expertise in evaluation of functional feeding skills and provides families support with these complex challenges. During a functional oral motor/feeding evaluation, your child will receive a clinical evaluation of oral motor/sensory skills and developmental feeding skills during directed play activities and with a mealtime/snacktime. Parents are encouraged to provide familiar food to make the evaluation as natural as possible. It is helpful to have some preferred foods that your child accepts, as well as foods that he/she refuses to eat available during the evaluation. Also, access to preferred utensils and cups may also be beneficial. Varieties of textures/flavors of foods may also be provided by the examiner. Your child may participate in the evaluation more readily if he/she is hungry; therefore, we prefer that parents not feed the child approximately 1-2 hours prior to the appointment time. Family members are encouraged to participate in this evaluation. Families should allow approximately 1-1 1/2 hours for the completion of this assessment. Following the assessment, the therapist will provide the family with recommendations and will follow up with a detailed evaluation report. Should the examiner deem appropriate, suggestions for referrals to other specialties such as otolaryngology, gastroenterology, pulmonary, nutrition, etc. may be provided.
Feeding Therapy Process:
Oral Motor/Feeding Milestones
This list is not meant to be a complete list. Please seek out professional assistance from your doctor or a feeding specialist if you have concerns.
An occupational therapy assessment is crucial to understanding your child's strengths and challenges; and needs to be completed prior to starting treatment. The evaluation includes standardized assessment; clinical observation; parent interview; and a teacher interview and school visit, if appropriate. Our goal during the evaluation process is to establish a baseline of skills, provide recommendations for ongoing therapy (if needed); provide strategies and activities for home and school; and provide parent education. Following your child's evaluation, a parent meeting will be scheduled to discuss the evaluation results, recommendations, and answer any questions you may have. A school meeting can also be scheduled to review evaluation results with your child's teachers.
The evaluation with the child usually takes from 1-2 visits. After the initial evaluation an appointment is scheduled with the parents to review the results and recommendations. If therapy is recommended, a treatment plan will be developed.
Assessments are provided in the following areas:
Evaluations may include the following assessments:
Examples of Conditions Requiring Possible Therapy
**Evaluations and treatments are offered in Concord at SensationAll Kids Gym, (www.sensationallkidsgym.com) complete with suspended equipment, trampolines, scooter boards, calming room with fiber optic equipment, ball pit, fine motor equipment and a designated kitchen area.
**Services are also available in the comfort of your home, which may be beneficial for children that are easily overstimulated.
**Services now available in Berkeley across the street from Whole Foods
Noble Therapy is partnering with SPG in Berkeley!!!