Since the purpose of the blog is to journal, as well as educate and explain, I am going to go into depth on the test, as well as the specific results for John and what it means for kids with these issues.
(the following information was taken from information put together by Casa Colina taken from A. Jean Ayres, Ph.D)
SIPT, Sensory Integration, and Praxis Defined
SIPT stands for Sensory Integration and Praxis Tests. They help us understand why some children have difficulty learning or behaving the way we expect them to. They are not measuring intelligence, language, academic achievement, or social behavior. But, the test assess sensory processing that relates to those functions and the ability of the child to perform in those arenas. The test also evaluates praxis, or the ability to cope with the tangible, physical, 2 and 3-D world.
I've blogged about Sensory Integration before, but to re-define it here, it is the neurological process by which sensations (through skin, eyes, joints, gravity, and movement) are organized for use. Our brain is working in the background to filter, discriminate, and modulate all the sensory information it receives.
Praxis is the ability by which we figure out how to use our hands and body in skilled tasks. (like playing with toys, using a fork, building a structure, cleaning a room, working a job) This includes knowing WHAT to do, as well as HOW to do it.
Children with a dysfunction in Sensory Integration and Praxis have difficulties with visual perception tasks and are inefficient with their interpretation of the sensations they receive from their body. In basic terms, these children have difficulty in organizing their body and their behavior.
SIPT in depth
There are 17 SIPT tests. Those tests fall into 4 Categories
1. Motor-Free Visual Perception
- ability to visually perceive and discriminate form and space without motor coordination
- child shown puzzle pieces and a form board; has to look at pieces and visually perceive which piece would fit without placing it or trying it in formboard
- when child makes decision, picks it up; examiner notes which hand was used, whether they crossed the midline
- continues to more advanced, where pictures are hidden among other pictures and child has to perceive a figure against a confusing background
- assesses tactile, muscle, and joint perception ("Soma" means "body")
- Child is encouraged to "feel", not "see"
- child must identify what shapes they are holding in their hand without looking
- Using cardboard, child's hands are placed underneath; examiner touches child on one of his/her fingers. Child must tell examiner which finger was touched
- being touched can make child uncomfortable, so examiner is looking for "tactile defensiveness"
- 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 put it
- the therapist will draw simple designs on back of child's hand and child must attempt to copy
- the therapist will lightly touch the child's arm with a black pen, leaving a dot (while child's arm is under cardboard). Child must try to touch the dot without looking (assessing whether the child felt the pen touching their skin and the accuracy of the sensation)
- assesses ability of child to interpret verbal instructions to assume certain positions with the body "put hands on top of head"
- evaluates the ability to copy simple designs
- evaluates ability to build with blocks (therapist models a structure they built and child must copy) ; evaulates visual form and space perception
- child imitates unusual body postures that are done by the therapist
- the child imitates movements and positions of the tongue, lips, and jaw ( oral praxis, oral motor)---a child with a deficit here would have eating and speech issues
- child imitates a series of simple arm and hand positions
- evaluates the ability to coordinate the two sides of the body
- assesses the degree of sensory integration of the proprioceptive sense (muscle and joint) and vestibular Sense (gravity and head movement)
- Eye hand coordination is measured; how well a child draws a line on top of a printed line -- executing this takes eye muscle control, practive ability, visual perception, and motor coordination
- measures the duration of the reflexive back and forth eye movements following the rotation of the body; it is a way to tell how well the nervous system integrates with the sensations from the vestibular system
When we need to do something with our bodies (play with a toy, write a note, type on the computer, walk across a room, do a jumping jack, lay down, sit on a chair, etc.), we need to:
1. have the idea of what to do
2.know how to execute it
3. physically execute what we want to do
In executing movement of our bodies, it involves fluidity and muscle control, as well as the actual execution of the movement. Children with sensory integration dysfunction cannot execute the movement accurately due to the inability of the brain to interpret and communicate the sensory information to the rest of the body. The nervous system is not receiving the appropriate "feedback" it needs to remain in a "calm" state and therefore, these children's nervous systems are always on "high alert" and in defense mode.
John's Results
The tests revealed that John has Dyspraxia and a Modulation Disorder;
specifically Visuo-and-Somotodyspraxia
Children in this group have low scores in Design Copying, Finger Identification, Graphesthesia(copying design therapist drew on hand), Postual Praxis, Sequencing Praxis, Bilateral Motor Coordination, Standing and Walking Balance, Motor Accuracy, and Kinesthesia (joint position and movement)
Understanding Modulation Disorder
A child out of the "normal", also known as "out of sync" can either fall into under responsive or over responsive to the sensory information.
Our brains are discriminating every sensation and then sending the message to our bodies to react to the sensation. A normal modulation leads to appropriate "feedback" for the nervous system, resulting in a calming, positive experience.
When our brains do not discriminate that information correctly, there is a modulation problem, leading to the under and over-responsive behaviors.
A child who is over-responsive to touch, for example, would over-react to stepping into sand. They won't be able to tolerate that touch and their behavior will reflect that, keeping the nervous system from ever receiving appropriate "feedback" to calm and enjoy it.
A child who is under-responsive takes longer to discriminate that sensation, therefore resulting in the need for "more" of the sensation, craving an abnormal amount of that sensation before the nervous system can become calm. In sand, that child may need to bury their bodies in it, roll around in it, squish in their hands, etc.
For John, he is under-responsive in tactile, vestibular, and proprioception. He may not know what he is feeling as he touches something if he is not looking at it. He craves lots of movement, swinging really high, thrill rides, bounces up and down, crashes into things like couches and furniture to get "feedback" for his nervous system, etc. Because of this, if he doesn't get "enough" feedback, then his behavior, his attention span, and his ability to sit and learn become effected.
He also seems to modulate sound and smell in the opposite direction, being over-responsive to those senses. If something smells bad, he no longer can concentrate, starts acting "crazy" and "loopy" and is no longer "in control" of his behavior. Loud sounds scare him, and can lead to anxiety over the anticipation of things like fireworks, blenders, hair dryers, etc.
What can be done to correct the modulation disorder, dyspraxia, and Sensory Processing Dysfunction?
The good news: LOTS OF THINGS can be done!!!
The key to John's success in overcoming the modulation, dyspraxia, and sensory processing issues will be to INTENSIFY every sensory experience he has to make sure his nervous system receives the "feedback" it needs from those experiences, so it can learn to be in a calm state. Our brains can learn to regulate themselves. Many of the things we have been doing over the last year incorporated many of these things, which would explain the significant gains he has made. Here are examples of things we can do in the home, as well as in therapy, to help John receive the appropriate level of sensory "feedback" to help regulate him to a "calm" state, for lack of better terms. ;)
Heavy in Proprioception; Intensifying every sensory experience
- Fingerpainting with sand in the fingerpaint
- Swimming
- Deep Pressure hugs, squeezes, massages
- Heavy "work" (push, carry, move)
- Use ankle weights (3 lbs. each ankle)
- Large trampoline
- Swing Set with tire swing, rock climbing wall, slides, swings, etc
- Shaving Cream in bathtub to fingerpaint with
- Barefoot outside
- Sandbox in backyard
- Bury toys in sand
- Hide toys in play dough
- "touch game" - find hidden objects where vision is blocked so only using hands to find the object
- start meals off with something more resistant / harder to chew like bagel, beef jerky, starburst, granola bar
- Extreme temp foods (not burning, but very hot or very cold)
- Use of straw in cups
- Use of twisty loop straw
- thick smoothie, shakes
- more sweet
- more tang
- INTENSIFY eating experience
