Observations

Question 1

Informal Observations

Answer 1

• attention, activity level
• effort, motivation
• pace, quality of work
• posture, muscle tone
• verbal / non-verbal skills
• ability to follow directions, sequence steps
• general affect and appearance
• environmental factors (noisy, poor lighting, etc.)

Question 2

Observations Specific to Visual-Perceptual / Visual Motor Testing

Answer 2

• Eye movements
• Rubbing of eyes
• Organization/Planning (L-R, T-B)
• Visual Neglect/Field Deficits
• Reversals
• Pencil grasp, pressure, handedness
• Accuracy of line intersections
• Attention to details
• Crossing midline
• Compensatory Strategies (Tracing with fingers, Talking self through the task)

Question 3

Observations during handwriting: (8 things)

Answer 3

1. Posture/Positioning
2. Pencil Grasp/Handedness
3. Approach to forming basic lines / shapes (L-R, T-B)
4. Copying (near/far point)
5. Forming from memory
6. Pressure (too hard/too soft, consistency)
7. Speed, Endurance
8. Sequencing, Organization, Approach

Question 4

Structured Clinical Observations for SPD:

Answer 4

1. Diadokokinesis
2. Sequential Finger Touching
3. Finger-to-Nose Test
4. Eye Movements (automatic eye movements; consciously directed eye movements)
5. Schilder’s Arm Extension Test
6. Antigravity Flexion / Supine Flexion
7. Antigravity Extension / Prone Extension
8. Postural Control
9. Protective Extension
10. Weight Bearing and Proximal Joint Stability
11. Gravitational Insecurity
12. Projected Action Sequences*
13. Bilateral Motor Coordination*
14. Reactions to Sensations* (response to vestibular info and movement during play; tactile play and response to tactile sensation)
15. Free Play and Play Preferences*
16. Praxis*

(*skills observed throughout)

Question 5

Diadokokinesis

Answer 5

Observe: smoothness/fluidity of movement, bilateral coordination

Interpret:

• traditionally for cerebellar integrity
• also an indicator of motor planning, sequencing, and processing of somatosensory information

Question 6

Sequential Finger Touching:

Answer 6

Observe: fluidity; timing/sequencing; ability to move fingers separately from each other, the rest of the hand, and the UE

Interpret:

traditionally for cerebellar function

also used to assess somatosensory processing needed to isolate finger movements for sequencing, that is nec. for motor planning

Question 7

Finger-To-Nose

Answer 7

Observe: fluidity/smoothness; R/L differences in actions; associated movements of the head and trunk

Interpret: cerebellar but also somatosensory; also copying simple actions that require motor planning

Question 8

Eye Movements: What to Observe

Answer 8

AUTOMATIC:

Observe moving eyes together; smooth movement across midline; convergence and divergence; ability to stabilize eyes; fluidity of bilateral ocular movement.

CONSCIOUSLY DIRECTED:

Observe maintaining visual focus on target, moving eyes smoothly, coordinating head and neck movements with eye movements; move eyes and head separately; coordinate both eyes together; note whether child can sustain visual focus on target during head movements

Question 9

Eye Movements: How to Interpret.

Answer 9

AUTOMATIC:

Interpret: related to visual, vestibular and prop. functions. Stabilizing eyes during head/body movement requires dynamic postural control.

CONSCIOUSLY DIRECTED:

Smooth eye movements while localizing/following object requires visually mediated ocular control. Also depends on stable posture, adequte head control, ability to tolerate visual movement.

Searching/localizing requires ocular motor planning. Active head movement w/ stable gaze requires vestib-prop. processing / postural stability.

Question 10

Schilder’s Arm Extension Test:

Answer 10

Observe ability to maintain arms in extended forward position w eyes closed.

Can head be moved easily? Any tremors in hands/fingers? Shoulders stable? Head, neck, trunk segmented? Differences between R/L UE in position? How’s balance w eyes closed?

Interpret: traditionally a neurological test of cerebellar integrity. In SI theory, the ability to dissociate head from UEs has been related to vestib./prop

Question 11

Antigravity and supine flexion:

Answer 11

structured: assuming flexion pos. on floor
unstructured: holding on / swinging from trapeze or monkey bar

Observe ability to get into position (motor planning), and whether flexion of UEs and LEs occurs at same time.

NOTE: How is the joint contraction? How long can child hold position? Does child use other strategies for maintaining position (i.e. stabilizing with other parts of body)?

Interpret: Flexor pattern associated with somatosensory (tactile, prop). Link to somatodypraxia. Also related to tactile/prop DISCRIMINATION as well as motor planning. Difficult w neck flexion in supine may be related to postural problem.

Question 12

Antigravity and prone extension:

Answer 12

Observe: ability to assume position; length of time pos. maintained; ability to hold oneself against resistance; quality of extension in head and shoulder girdle; if/how much upper torso/thighs are off ground

NOTE: Can child sustain extension with entire body? Head, shoulders, upper back, thighs, legs?

Interpret: vestib; also considered in conjunction w vest/prop processing; related to motor planning, too; inability to maintain postural extension against gravity is one indicator of postural-ocular movement disorder

Question 13

Postural Control:

Answer 13

When moving surface on which child is sitting (i.e. therapy ball), observe postural reactions, compensatory postural adjustments, awareness of body positions.

Interpret: equilibrium reactions contribute to postural control and may occur in response to externally imposed force (reactice) or may occur in response to self-initiated movement. In SI, postural control is related to visual, vestibular and prop. Anticipatory control is dependent on integration of vestibular and prop.

Question 14

Protective extension:

Answer 14

Move child forward (usually over therapy ball) to floor, and observe: protective reactions of arms in direction of fall. Note speed and effectiveness of child’s ability to bring arms out in protective motion.

Interpret: Protective reactions depend upon vestibular processing. Immature or poor responses may indicate decreased vestibular function.

Question 15

Weight bearing / proximal joint stability:

Answer 15

During weight-bearing (i.e. in wheelbarrow or over ball), observe: hand adjustment, scapula position (winging?), locked elbows, lordosis or trunk.

Interpret: SI theory says poor proximal joint stability in shoulder girdle/neck is associated with poor vestibular and prop. Poor proximal joint stability in other parts of the body may be associated with decreased muscle tone and inadequate prop. input.

Question 16

Gravitational insecurity:

Answer 16

When child has to lift feet off floor or tilt head back, observe level of fear/anxiety. Note extreme need to hold on or SEE in order to feel safe. Note differences in reaction to movement in varying directions, speed, heights, and amount of active vs. passive motion.

Interpret: GI may be related to modulation of vestibular, prop and visual, as well as autonomic NS function.

Question 17

Projected Action Sequences:

Answer 17

During unstructured activities such as throwing a ball, kicking a ball, running to catch or kick, observe coordination, speed and accuracy. Note ability to anticipate and prepare body for motor response.

Interpret: Poor anticipation may be linked to vestib. / prop. May be related to sequencing praxis when activity involves bilateral coordination. Kids w somatodyspraxia also have trouble here. Motor planning components including sequencing, timing are involved.

Question 18

BMC

Answer 18

Bilateral motor coordination can be formally assessed during BOT or SIPT. Doing unstructured tasks like pumping on swing, bike riding, jumping jacks, opening a jar, holding paper and cutting, observe: coordination of both sides of body, front and back of body, upper and lower parts of body. Note body awareness, postural control, praxis.

Interpret: BMC associated w vestib./prop. Bilat Coor and sequencing also associated w somatodyspraxia. With older kids, bliateral MC should be assessed in more demanding tasks.

Question 19

Reactions to sensations, vestibular/movement:

Answer 19

During activity requiring vestibular and movement input (i.e. swing), observe child for stability and mobility s/he has to stay upright against gravity. Observe maintenance and awareness of body position, balance, postural adjustments, response to movement and gravity, coordination of head, neck, eyes, and body during movement.

Interpret: modulation/discrimintation of single and multiple sensory sources; emotion, cognition, motor performance, attention, behavior. Poor registration or hypo responsiveness to vest/prop. Trouble holding still may indicate hype-response to gravity. Trouble w postural control may indicate trouble w rapid, efficient processing of vest input.

Question 20

Reactions to sensations, tactile:

Answer 20

Observe child’s ability to determine where touch is applied, what shapes/textures are being touched (with and without vision), tendency to explore using touch. Note registration of touch sensation, comfort w difference textures, accuracy of tactile discrimination (stereognosis, spatial awareness, duration, type of touch).

Interpret: Poor registrationg or localization may indicate hypo response to tactile input. Withdrawing or anxiety from it may indicate tactile defensiveness or tactile modulation disorder.

Question 21

Free play and play preferences:

Answer 21

Observe child’s choice of equipment or activity; imagination and creativity; playfulness. Note quality and complexity of play, social aspects of play.

Interpret: Child’s choice provides info about child’s intrinsic motivation and sensory preferences, offers info about ideation, motor planning, sensory preferences, social skills.

Question 22

Praxis:

Answer 22

Observe child’s abilities with regard to planning, timing, imitation, sequencing, translating verbal directions into actions, construction. Note amount of trail and error needed; need for direction, guidance, demo; avoidance of anything.

Interpret: SI says praxis has both conceptual and motor functions. Good praxis skills are dependent on good sensory perception, esp. tactile, prop and vestibular sensory processing.