Clinical observations

CLINICAL OBSERVATIONS BASED SI FRAME OF REFERENCE Name: ________________ Test Date: ________________ Birth Date: _____________________ Age:______________ Poor Sensory Modulation 1.GRAVITATIONAL INSECURITY - Normal reaction to change in body position + Fear reaction out of proportion to actual danger 2.AVERSIVE RESPONSE TO MOVEMENT - No evidence of aversive responses + Feelings of discomfort (nausea, vomiting, vertigo, dizziness) to movement 3.TACTILE DEFENSIVENESS - Tolerates variety of tactile stimuli + Overreacts or aversion to tactile stimuli 4.AVOIDANCE OF SENSORY EXPERIENCES - Seeks new & challenging experiences + Avoids unfamiliar activities or sensory stimuli 5.HYPERRESPONSIVE TO SMELL - No evidence of aversive responses + Overreacts or aversive response to smell 6.HYPERRESPONSIVE TO SOUND - No evidence of aversive responses + Overreacts or aversion to noise 7.DISTRACTIBILITY - No evidence of unusual tendency to attend to irrelevant stimuli + Attends to irrelevant stimuli; difficulty attending task 8.LEVEL OF ACTIVITY - Level of motor & verbal activity appropriate to situation + Unusually high levels of activity or difficulty transitioning from active to quite activities

1.PRONE EXTENSION - Extends body against gravity easily for 20-30 sec + Difficulty extending body against gravity 2.PROXIMAL STABILITY IN QUADRUPED - Stabilize scapulae, back, elbows during weight bearing + Lordosis, hyperextends or locks elbows or scapulae wing 3.EXTENSOR MUSCLE TONE - No evidence of low tone + Lordosis & hyper extended knees in standing, “mushy” muscles when palpated 4.EQUILIBRIUM - Makes postural adjustments of uphill limbs & maintains head or upper trunk upright + Does not maintain head/upper trunk upright or make postural adjustments of uphill libs to maintain balance 5.NECK FLEXION IN SUPINE - Flexes neck & no head lag when assuming supine flexion + Head lag (leads with chin) when assuming supine position 6.POSTURAL ADJUSTMENT - Appropriate postural adjustments to support limb movements + Exaggerated, awkward, inappropriate or diminished postural adjustments

Page3

DIFFICULTY WITH POSTURE

CLINICAL OBSERVATIONS BASED SI FRAME OF REFERENCE

POOR BILATERAL INTEGRATION AND SEQUENCING (BIS) 1.MIXED HAND PREFERENCE - Consistently uses the same hand for given task + Sometimes uses right & sometimes uses left hand to perform the same task (or history of doing so) 2.CROSSING THE MIDLINE - Spontaneously crosses midline of body + Avoids crossing midline 3.RIGHT-LEFT CONFUSION - Correctly identifies right & left or knows but cannot label correctly + Confuses right & left 4.PROJECTED ACTION SEQUENCES & BILATERAL MOTOR SKILLS a. CATCHING A BOUNCED BALL - Able to catch bounced ball when force or direction varies + Difficulty catching bounced ball when force or direction varies b. HOPPING/JUMPING IN SERIES OF CIRCLES - Able to jump in a series with both feet together, without stopping + Cannot jump with feet together, breaks task apart into jumps, difficulty terminating series c. SKIPPING - Skips in a fluid, reciprocal manner + Unable to skip; breaks into step-hop pattern d. JUMPING JACKS - Able to simultaneously open & close arms & legs & jump in smooth series + Moves arms or legs segmentally while jumping or difficulty performing a series of jumps e. SYMMETRICAL STRIDE JUMPING - Simultaneously swings ipsilateral arm and leg forward and backward while performing a series of jumps + Unable to move ipsilateral arm and leg simultaneously, segment jumps, unable to perform a series of jumps f. RECIPROCAL STRIDE JUMPING - Simultaneously swings contra lateral arm and leg forward and backward while performing a series of jumps + Unable to move contra lateral arm & leg simultaneously, segments jumps, unable to perform a series of jumps g. STEPPING OVER A MOVING OBJECT - Able to plan and execute movement over moving object without object hitting client + Object hits client with attempt to step over moving object

Page3

Comments:

CLINICAL OBSERVATIONS BASED SI FRAME OF REFERENCE SOMATODYSPRAXIA 1.SUPINE FLEXION - Able to assume & maintain body in total flexion easily 20-30 sec + Unable to assume or maintain position 2.SEQUENTIAL FINGER TOUCHING - Able to oppose thumb to each finger bilaterally in smooth sequence + Unable to touch thumb to fingers in smooth sequence, visual monitoring required 3.IN-HAND MANIPULATION - Able to manipulate objects within hand + Must use two hands or place object on table to manipulate objects 4.DIADOKOKINESIA - Pronation or supination in continuous bilateral sequence + Segmented movements, poor bilateral coordination Other Clinical Observations That May Suggest CNS Immaturity Or Be Common In Individuals With Sensory Integrative Dysfunction 1.ASSOCIATED MOVEMENTS - No evidence of extraneous movements or overflow when performing developmentally appropriate tasks; some overflow when performing difficult tasks + Excessive extraneous movements or overflow when performing developmentally appropriate tasks 2.FINGER TO NOSE - Alternately and accurately touches nose with finger + Diminished accuracy touching nose; over- or undershoots 3.SLOW (RAMP) MOVEMENTS - Able to flex and extend elbows in smooth, bilateral, symmetrical pattern + Moves arms segmentally or unable to move both arms simultaneously 4.PROTECTIVE EXTENSION OR SUPPORT REACTIONS - Extends downhill limb when balance is lost; supports weight on “weight-bearing” limb + Delayed extension of downhill limbs when balance is lost; difficulty shifting weight onto “weight-bearing” limbs VISUALLY CONTROLLED EYE MOVEMENTS 1.TRACKING - Able to easily follow small objects with eyes + Loses object; eyes not well coordinated; tires easily 2.CONVERGENCE OR DIVERGENCE - Able to easily follow small objects with eyes + Eyes not well coordinated; tires easily 3.QUICK LOCALIZATION - Able to easily follow small object with eyes + Eyes not well coordinated; tires easily Indicates evidence of difficulty or dysfunction Indicates NO evidence of difficulty or dysfunction

Page3

+ -