sensory processing and learning disabilities: case studies ...€¦ · sensory processing and...

Tim Conway, PhD*

Diana Croom-Atkins, OTD, OTR/L!

The Morris Center*! Ocala and Gainesville, FL

Neuro-development of Words – NOW!* International

The Einstein School* (a free, public charter school for children with dyslexia)

University of Florida* Dept. of Clinical and Health Psychology

Dept. of Speech, Language and Hearing Sciences

Sensory Processing and Learning Disabilities: Case

Studies of a Neurodevelopmental Approach to Assessment

& Successful Treatment in a Pediatric Population

- learn a neurodevelopmental model of phonological

awareness, spoken language and written language that is

based on mutlisensory processing.

- discover how multi- and sensory processing aid the

development of fine motor skills, occulo-motor skills, oral

motor, somatosensory and motor articulatory, postural control,

general motor praxis, language skills, and reading and writing

- understand the relationship between sensory processing and

motor deficits and learning disabilities.

- explore how a transdisciplinary team follows neuro-

developmental models during assessment and treatment

Learning Objectives:

“Learning and behavior are the visible aspects of sensory integration.” (Ayres, 2005, p. 27)

“Reading, writing, and arithmetic…are extremely complex processes that can develop only upon a strong foundation of sensory integration.” (Ayres, 2005, p. 11)

Promoting Academic Success

Attention

Sensory, Motor skills & Modulation

Learning & Memory skills

Spoken & Written Language skills

Psychological health

– self-esteem, interpersonal skills, regulation of

mood or anxiety

Behaviors for learning & achievement –

- engagement, motivation, compliance

Executive Functions

– planning, organizing, managing time

What to do?

If attention, sensory, motor, visual, language,

memory, executive functions and psychosocial

skills contribute to academic and life success,

then which professions can assess & treat

deficits in these systems?

Medical providers

Speech-Language Pathology

Occupational Therapy

Neuropsychology/Clinical Psychology

A team of providers, but what type of team?

Transdisciplinary vs Multidisciplinary

Transdisciplinary Team Building

Team is built with:

1. Shared neurodevelopmental

models of function

2. Cross-trained in each discipline’s

treatments methods and goals

3. Creating an integrated immersion

environment for treatment

4. Shared understanding of

tenets of neural plasticity

Grant, Finocchio et al., (1995)

Interactive Transdisciplinary Team Transdisciplinary review of assessment data

Transdisciplinary diagnoses

Transdisciplinary team goals for patient

Transdisciplinary members are interdependent for patient’s treatment progress

Clinical environment enables collaboration:

- weekly transdisciplinary team rehab staffing

- daily/hourly hallway consultations

- weekly parent education meetings w/ psychologist

Drinka & Clark (2000).

http://dcahec.gwumc.edu/education/files/session3/index.html

Interactive Transdisciplinary Team

Advantages Disadvantages 1. Integrated care

2. Shared leadership

responsibility

3. Solutions to complex problems

4. Solutions with depth & breadth

5. Members are empowered

6. Creative approaches to

complexity

7. Understand autonomous

practice

1. Initial decisions take more

time

2. Members must learn different

languages/norms

3. Effort to maintain the team

4. Need time and space to:

‐Clarify values

‐Renegotiate roles

‐Renegotiate leadership

‐Manage and resolve conflicts

NEURONS & LEARNING Tenets of Neuroplasticity

Neuroplasticity or LEARNING is promoted by: 1. Intensity - # of hours per day 2. Frequency - # of days per week 3. Specificity – explicit instructions/methods 4. Neurodevelopmental Hierarchy – training basic skills before advanced skills 5. Duration – # of weeks of treatment

Shared Neurodevelopmental Models

of Function Relative to Treatment

Goals

Developmental “Language Building Blocks”

building a solid foundation for reading

C O M P R E H E N S I O N

(MEANING)

(FORM)

READING

WRITING

SPELLING

METALINGUISTICS

SOUND OUT

WORDS (phonology/decoding)

SIGHT WORDS (Visual Memory)

SIGHT WORDS (visual memory)

VOCABULARY (Semantic Knowledge)

VOCABULARY (semantic knowledge)

SYNTAX

R E A D I N G F L U E N C Y

MORPHO-

SYNTACTIC

Typical READING Development

PHONICS RULES

SYNTACTIC

SEMANTIC/

LEXICAL

EXECUTIVE FUNCTION / INTENTION

WORKING MEMORY (HOLD / MANIPULATE)

ORTHOGRAPHIC ARTICULATORY PHONOLOGIC PROSODIC

ATTENTION / AROUSAL

(Alexander & Slinger, 2004)



ACOUSTIC VISUAL ORAL MOTOR SOMATOSENSORY

ATTENTION / AROUSAL

PHONEMIC REPRESENTATION

PROSODIC (WORD LEVEL)

(Alexander & Slinger, 2004)

PHONOLOGY

(PERCEPTION & PRODUCTION)

18 MONTHS

5 YEARS

9 YEARS

1 MONTH

9 MONTHS

PHONOLOGY

(FORM)

PRAGMATICS

(FUNCTION)

SEMANTICS

(MEANING)

SYNTAX

(FORM)

READING

WRITING

SPELLING

METALINGUISTICS

Developmental Building Blocks

for Language (Alexander & Heilman, 2006; adapted)

Re

cep

tiv

e L

an

gu

ag

e

Ex

pre

ssiv

e L

an

gu

ag

e

STG (bilateral)

acoustic-phonetic

speech codes pMTG (left)

sound-meaning interface

Area Spt (left)

auditory-motor interface pIFG/dPM (left)

articulatory-based

speech codes

Hickok & Poeppel (2000), Trends in Cognitive Sciences

Hickok & Poeppel (2004), Cognition

STS phoneme

representations

UNIQUE AND OVERLAPPING NETWORKS SENTENCE/SYNTACTIC, SEMANTIC, PHONOLOGICAL (Vigneau, et al., 2006)

“OUT OF LINE NEURONS” (ECTOPIAS)

FRONT BACK

Does Neuronal

migration

goes awry in

developmental

dyslexia?

www.thebrain.mcgill.ca

NEURONAL

MIGRATION and

“OUT of LINE

NEURONS”

Neuronal Ectopia

(Ramus, 2004)

Biology (RAMUS, 2004)

Behavior

Cognition

THEORETICAL

DEVELOPMENTAL DYSLEXIA: A MOTOR-ARTICULATORY FEEDBACK HYPOTHESIS

(HEILMAN, VOELLER, ALEXANDER, 1996 Annals of Neurology)

“The inability to associate the position of their articulators with speech sounds may impair the development of phonological awareness and the ability to convert graphemes to phonemes. Unawareness of their articulators may be related to programming [sensory integration] or feedback [sensory perception] deficits.”

MORPHO-

SYNTACTIC

Atypical READING - Dyslexia

PHONICS RULES

SYNTACTIC

SEMANTIC/

LEXICAL



ORTHOGRAPHIC ARTICULATORY PHONOLOGIC PROSODIC

ATTENTION / AROUSAL

WHAT DYSLEXIA IS NOT

DYSLEXIA…

.. is NOT A VISUAL PROBLEM

.. is NOT A LACK OF INTELLIGENCE

.. is NOT DUE TO LACK OF EFFORT

.. is NOT RESPONSIVE TO STANDARD READING

INSTRUCTION

.. is NOT UNCOMMON: 5–17.5 % OF POPULATION

.. is NOT A DEVELOPMENTAL LAG

DYS = TROUBLE LEXIA = WORDS

DYSLEXIA IS…

NEUROLOGIC IN ORIGIN – GENETIC

LIFELONG – ENVIRONMENT MAY ALTER COURSE

CORE DEFICIT=PHONOLOGICAL AWARENESS (LANGUAGE)

READING COMPREHENSION > WORD READING SKILLS

DYSLEXIA MAY INCLUDE ACCOMPANYING

CHALLENGES

ADHD (50-70%)

BEHAVIORAL PROBLEMS

SENSORY MOTOR DIFFICULTY

= MORE CHALLENGING TO REMEDIATE

THE PICTURE OF DYSLEXIA (ALL SYMPTOMS DO NOT OCCUR WITH EVERYONE)

ORAL LANGUAGE

CHALLENGES

LISTENING

Auditory Memory (word sequences,

phone numbers,

remembering directions)

Phonological

Awareness

Foreign

Language

SPEAKING

Word Finding

Multi-syllable Words

Sequencing Ideas

Foreign Language

WRITTEN LANGUAGE CHALLENGES

READING

Mechanics Comprehension

Speed Mechanics

Speed

SPELLING & WRITING

Expressing Ideas


ACCOMPANYING CHALLENGES (BEHAVIORAL)

Parents with similar challenges

Brain /

Behavior

Disorders

Attention & Executive

Function

Anxiety

Depression

OCD

Oppositional

Behavior


ACCOMPANYING SENSORIMOTOR CHALLENGES

Up/Down

Left/Right

Oral Motor Messy Eating

Writing/knots Fingers

Eyes

Tired

Words Swim

Lose Place

Spatial Awareness


Praxis

Disciplines:

Neuropsychology

Psychiatry

Clinical Psychology


Speech-Language Pathology

Education

Transdisciplinary Team for

Assessment & Treatment

Why would you need occupational therapy as part of a treatment team for Language Disorder, Learning Disability or Dyslexia?

“Sensory Integration sorts, orders, and eventually puts all of the individual sensory inputs together into whole brain function” (Ayres, 2005, p. 28)

“Learning and behavior are the visible aspects of sensory integration.” (Ayres, 2005, p. 27)


Research shows that more than 50 percent of individuals with learning difficulties may also have sensorimotor difficulties. Occupational Therapists are the experts on the development of sensory and motor skills. These skills are other foundational skills, besides language, that can affect the development of academic skills or interfere with academic performance. The individual who has language and sensorimotor deficits are struggling even harder to develop their skills and perform daily activities. Sensorimotor difficulties may include:

•ORAL-MOTOR AND MOTOR PLANNING DIFFICULTY •FINE AND GROSS MOTOR DIFFICULTIES – TROUBLE TYING A SHOE, CUTTING WITH SCISSORS, EATING WITH UTENSILS or JUMPING ROPE •VISUAL PERCEPTUAL DELAYS – POOR DEPTH PERCEPTION or FIGURE GROUND •SOMATOSENSORY DEFICITS – POOR BODY AWARENESS, COORDINATION, or CLUMSINESS •SENSORY HYPERSENSITIVITY – OVERLY SENSITIVE TO SMELLS, TASTES, ETC…

5 to 10 hours of OT per week

Transdiciplinary team understands the close relationship

between language-based learning & sensorimotor difficulties

Therapists confer daily regarding treatment progress

OT Goals = improve overall core strength, balance, visual

processing, sensory processing and coordination.

Strengthening these areas will help improve sensorimotor

skills, sensorimotor foundations of language skills, academic

skills, build self-confidence and enhance self-esteem.

“Society is placing more emphasis on language, academic, and intellectual development, and less on building the sensorimotor foundations for these higher functions.” (Ayres, 2005, p. 141)

TMC – Occupational Therapy Objectives

Assess, educate, communicate, and plan to: Address the sensory processing, sensorimotor, and arousal state modulation challenges of each client to optimize their learning potential throughout the day

Facilitate generalization of these skills into each person’s activities of daily living.

Provide sensory-based occupational therapy intervention to:

Find the just right challenges to facilitate more functional responses to sensation in active, meaningful, and fun ways so the client is able to develop more appropriate and/efficient adaptive responses/behaviors in academic, social, and self-care activities.

Provide recommendations and education for:

Accommodations, adaptive equipment, or modification of activities to optimize positioning and provide support as needed to meet each clients’ individual needs as they develop endurance, stamina and skills in dynamic academic, physically active and social settings at TMC and in their daily lives.

Sensory Processing refers to the ability of the nervous system to register,

organize, and use sensory information. This includes information from the three “body senses,” which are the foundation for other sensory skills as well as the

integration of sensory and motor systems and the integration of perceptual and motor systems (Miller). If any of the steps in the pyramid are weak or have not

developed efficiently, it can cause difficulties and challenges in the higher levels of learning.

(Miller, 2011)

Vestibular system (balance and sense of movement and gravity) is the most powerful and crucial part of the sensory system. Proprioceptive system (position sense) refers to the sensory input and feedback that tells us about our body’s movement and position in space based on information from our muscles, joints, ligaments, tendons, and connective tissues. Tactile system processes information from our environment based on our sense of touch. There are many types of touch receptors including deep pressure/light touch, temperature, and pain receptors. Auditory processing is related to listening and discriminating the differences in sounds. Even though hearing may be normal, when there are difficulties with auditory processing there is a mismatch in the ability to interpret or discriminate sounds. This can impact academic skills including language development, reading, spelling and being able to follow directions.

Visual Perceptual Skills involve the ability to organize and interpret the information that is seen, and give that information meaning. Some examples of visual perceptual skills include those that are important in navigating everyday life and academics: Visual Discrimination – recognizing differences between similar objects Visual Memory – being able to hold the visual image of an object in memory for a brief period of time and choose it from among similar items Spatial Relations – accurately perceiving the position of objects in relation to oneself or other objects Visual Form Constancy – recognizing an object despite changes in size, shape, or orientation Visual Sequencing – being able to remember (the order or sequence) of a series of forms or characters Figure-Ground – finding an object in a complex background Visual Closure – being able to infer what an object is based on by seeing partial information about that object

Reflexes The Moro Reflex occurs in response to loss of support of the head and upper body. A child who has not integrated the Moro reflex efficiently will often be in a high-alert or stressed state. The Moro and the TLR are also closely linked and involved in vestibular (balance) processing. The Tonic Labyrinthine Reflex (TLR) comes in two forms in response to movement of the head (vestibular/proprioceptive processing). When not integrated efficiently, the TLR can impact motor development, muscle tone, postural control and gravitational security. The TLR supports the development of other reflexes into more mature movement patterns including the STNR and the ATNR. The Symmetrical Tonic Neck Reflex (STNR) involves the bending of the elbows when the neck is flexed and knees are bent. This reflex helps prepare babies for learning to crawl on hands and knees. When present in older children, the STNR may interfere with postural control, gross and fine motor movement and ocular motor control. The Asymmetrical Tonic Neck Reflex (ATNR) occurs when the head is turned to the side and the arm on the same side extends outward. This reflex assists an infant when reaching for objects and for learning to roll over. When not integrated efficiently, it may contribute to head-turning during visual motor activities, difficulty with motor planning and praxis with activities off of mid-line as well as rotational activities. When present in older children, the ATNR may interfere with daily performance in movement, activities of daily living and academic activities.

Postural control is the ability of the body to stay upright against the pull of gravity and to adjust one’s posture to keep from falling down. Postural control, joint stability, and strength and endurance are heavily reliant upon respiration efficiency, visual, vestibular, and proprioceptive information. Postural control provides a base of support for the arms and legs to work from and provides the stability for ocular motor and visual perceptual skills to develop in order to perform activities of daily living, movement and coordination activities, as well as academic skills (cutting, drawing, writing, copying from the board or book/paper at a desk). Praxis is the ability of the brain and body to use sensory information in order to perform activities and involves a number of skills and abilities. Motor planning is one of those abilities and involves having an idea, planning the movements, and executing the plan. Once a movement pattern for a new skill becomes proficient, motor planning becomes automatic. Gross motor skills require use of large muscle groups to perform tasks such as walking, balancing, and crawling

Fine motor skills require use of smaller muscle groups to perform tasks that are precise in nature, such as writing and typing.

Oculomotor control refers to the ability of the eyes to locate objects in the environment, and maintain focus on a moving object. Deficits with these skills will likely impact visual attention to tasks and activities as well as performance in academics. Graphomotor production refers to the quality of handwriting/drawing/copying. Pencil grip and the pressure used when writing can affect the quality and speed of grapho-motor production. Visual-motor integration refers to the ability to use visual information to motor plan and to execute motor movements. Tracing, copying designs, taking notes from a blackboard and physical education activities are a few of the academic tasks that require solid visual-motor integration skills. Integrating visual information with motor skills often relies heavily upon one’s posture to provide joint stability for the hands to perform intricate movements and sensory processing of vestibular, proprioceptive, tactile, and visual information.

Core Concepts of Sensory Integration….

- provides a foundation for learning and behavior. All

sensory systems are important contributors to learning

and behavior. The body related senses of tactile,

vestibular, and proprioception provide reference points

relating to the body and its place in the environment – a

critical component to all learning and behavior.

- is a developmental process

- promotes neuroplasticity. Neuroplasticity is the ability to

change in response to environmental input and

demands. Lane and Schaaf concluded the literature

related to neuroplasticity supports the concept that

changes in neural function are possible and that

meaningful sensory-motor activities mediate these

changes. (Schaaf & Mailloux, 2015)

SENSORY INTEGRATION ADAPTIVE

(comparing & using multi-sensory input & RESPONSE dynamically adjusting output)

SENSORY MODULATION (Am I safe?)

DEFENSIVNESS (REGISTERS TOO MUCH SENSATION)

- DORMANT OR DIMINISHED (LOW REGISTRATION)

SENSORY ORIENTING (Where is it)?

INPUT

SENSORY REGISTRATION &

DISCRIMINATION (What is it?)

----

} ELEMENTS OF SENSORY PROCESSING

Case Study One: A2015 – Winter

8 year old male

OT – 2 hours/day, 5-days/week Language – 2 hours/day, 5-days/week

TEST OF VISUAL PERCEPTION (Non-Motor) SKILLS–3rd Ed.

Composites and

Subtests

Initial testing

(12/2014)

Post-Therapy

Standard or

Scaled Score

Standard or

Scaled

Score

Percentile

Rank

Descriptive

Category

Perceptual Quotient 90 90 25th Average

Basic Processes† 96 99 47th Average

Visual Discrimination 8 10 50th Average

Visual Memory 11 7 16th Low Average

Spatial Relations 13 17* 99th Upper Extreme

Form Constancy 5 5 5th Below Average

Sequencing 75 75 5th Below Average

Sequential Memory 5 5 5th Below Average

Complex Processes† 85 80 9th Below Average

Figure-Ground 8 6 9th Below Average

Visual Closure 6 6 9th Below Average

Bruininks-Osteresky Test of Motor Proficiency, 2nd Ed.

Composites and Subtests

Initial testing

(12/22/14)

Post-Therapy

Standard or

Scaled Score**

Standard

or Scaled

Score**

Percentile

Rank

Descriptive

Category

TOTAL MOTOR COMPOSITE 32 38* 12th Below Average

Fine Manual Control

Composite 32 33 5th Below Average

Fine Motor Precision 5 6 4th Well Below Average

Fine Motor Integration 8 8 8th Below Average

Manual Coordination

Composite 37 47* 38th Average

Manual Dexterity 12 18* 73rd Average

Upper-Limb Coordination 7 10 16th Below Average

Body Coordination

Composite 30 44* 27th Average

Bilateral Coordination 3 10* 16th Below Average

Balance 8 16* 52nd Average

Strength and Agility

Composite 38 40 16th Below Average

Running Speed & Agility 10 10 16th Below Average

Strength 8 12* 27th Average

Composites and

Subtests

Initial testing

(12/29/14)

Post-Therapy

Standard or

Scaled Score

Standard or

Scaled

Score

Percentile

Rank

Descriptive

Category

Phonological Awareness 82 116* 86th Above

Average

Elision 8 9 37th Average

Blending Words 9 12* 75th Average

Phoneme Isolation 4 16* 98th Above

Average

Phonological Memory 79 85 16th Low Average

Memory for Digits 8 7 16th Low Average

Nonword Repetition 5 8* 25th Average

Rapid Symbolic Naming 82 88* 21st Low Average

Rapid Digit Naming 6 8* 25th Average

Rapid Letter Naming 8 8 25th Average

Alternate Phonological

Awareness 67 113* 81st High Average

Blending Nonwords 6 12* 75th Average

Segmenting Nonwords 3 12* 75th Average

COMPREHENSIVE TEST OF PHONOLOGICAL PROCESSING-2ndEd

LINDAMOOD AUDITORY CONCEPTUALIZATION TEST, 3rd EDITION (LAC-3)

Composite and

Subtests

Initial testing

(12/23/14)

Post-Therapy

Standard or

Raw Score

Standard or

Raw Score

Percentile

Rank

Descriptive

Category

LAC-3 95 111* 77th High Average

Isolated Phoneme

Patterns 15/16 16/16

Not applicable

Tracking

Phonemes

(Monosyllables)

4/18 10/18

Counting Syllables

(Multisyllables) 7/10 2/10

Tracking Syllables

(Multisyllables) 1/10 7/10

Tracking Syllables

and Phonemes

(Multisyllables)

N/A 3/12

Case Study Two: R2014 - Fall

13 year old female

OT – 1 hour per day, 5-days/week Language – 4 hours per day, 5-days/week

TEST OF VISUAL MOTOR INTEGRATION - (VMI)

Subtests

Initial

testing

(7/2014)

Post-Therapy

Standard

Score

Standard

Score

Percentile

Rank

Descriptive

Category

Visual-Motor

Integration 86 105* 63rd Average

Visual Perception 105 97 42nd Average

Motor

Coordination 77 105* 63rd Average

Bruininks-Osteresky Test of Motor Proficiency, 2nd Edition


Initial

testing

(07/2014)

Post-Therapy

Std or SS Std or SS Percentile

Rank

Descriptive

Category

TOTAL MOTOR COMPOSITE 40 49* 46th Average

Fine Manual Control Comp. 54 42 21st Average

Fine Motor Precision 20 10 16th

Below

Average

Fine Motor Integration 14 14 42nd Average

Manual Coordination Comp. 36 55* 69th Average

Manual Dexterity 9 18* 73rd Average

Upper-Limb Coordination 10 16* 52nd Average

Body Coordination Comp. 37 50* 50th Average

Bilateral Coordination 10 19* 79th Average

Balance 9 11 21st Average

Strength and Agility Comp. 46 52* 58th Average

Running Speed and Agility 14 17* 66th Average

Strength 12 15* 50th Average



Initial testing

(08/2014)

Post

Standard or

Scaled Score

Standard or

Scaled

Score

Percentile

Rank

Descriptive

Category

Phonological Awareness 103 125* 95th Above Average

Elision 10 12* 75th Average

Blending Words 12 15* 95th Above Average

Phoneme Isolation 9 14* 91st Above Average

Phonological Memory 79 98* 45th Average

Memory for Digits 8 9 37th Average

Nonword Repetition 5 10* 50th Average

Rapid Symbolic Naming 95 95 37th Average

Rapid Digit Naming 11 10 50th Average

Rapid Letter Naming 7 8 25th Average


Awareness 79 113* 81st High Average


Segmenting Nonwords 7 14* 91st Above Average

Composite and

Subtests

Initial testing

(08/2014)

Post

Standard or

Raw Score

Standard or

Raw Score

Percentile

Rank

Descriptive

Category

LAC-3 100 119* 90th Above Average

Isolated Phoneme


Not applicable

Tracking

Phonemes

(Monosyllables)

12/18 15/18

Counting

Syllables

(Multisyllables)

10/10 10/10

Tracking

Syllables

(Multisyllables)

7/10 10/10

Tracking Syllables

and Phonemes

(Multisyllables)

4/12 12/12

LINDAMOOD AUDITORY CONCEPTUALIZATION TEST, 3rd ED

Subtest

Initial Testing

(02/15)

Post

Scaled

Score

Scaled

Score

Percentile

Rank

Descriptive

Category

Phoneme

Reversal 10 15* 95th

Above

Average

COMPREHENSIVE TEST OF PHONOLOGICAL PROCESSING

Case Study Three: J2015- Winter

15 year old female

OT – 2 hours per day, 5-days/week Language – 4 hours per day, 5-days/week

Composites and

Subtests

Initial testing

(02/2015)

Post-Therapy

Standard or

Scaled Score

Standard or

Scaled

Score

Percentile

Rank

Descriptive

Category

Perceptual Quotient 69 80* 9th Below Average

Basic Processes 59 75 5th Below Average

Visual

Discrimination 1 2 <1st Lower Extreme

Visual Memory 1 7* 16th Low Average

Spatial Relations 2 7* 16th Low Average

Form Constancy 3 4 2nd Below Average

Sequencing † 80 95 37th Average

Sequential Memory 6 9 37th Average

Complex Processes 85 83 13th Below Average

Figure-Ground 7 8 25th Average

Visual Closure 7 5 5th Below Average

TEST OF VISUAL PERCEPTION (Non-Motor) SKILLS–3rd Ed. (TVPS-3)


Initial testing

(02/2015)

Post-Therapy

Std or SS Std or SS Percentile Descriptive Cat.

27 1st Well Below Avg TOTAL MOTOR COMPOSITE 28

Fine Manual Control Comp. 31 31 3rd Below Average

Fine Motor Precision 6 6 4th Below Average

6 4th Below Average Fine Motor Integration 5

27 1st Well Below Avg Manual Coordination Comp. 29

Manual Dexterity 3 4 1st Well Below Avg

5 2nd Well Below Avg Upper-Limb Coordination 5

Body Coordination Composite 26 26 1st Well Below Avg

5 2nd Well Below Avg Bilateral Coordination 3

Balance 4 4 1st Well Below Avg

26 1st Well Below Avg Strength and Agility Comp. 30

Running Speed and Agility 4 4 1st Well Below Avg

Strength 4 4 1st Well Below Avg

Bruininks-Osteresky Test of Motor Proficiency, 2nd Edition

Composites and

Subtests

Initial testing

(02/2015)

Post-Therapy

Standard or

Scaled Score

Standard

or Scaled

Score

Percentile

Rank

Descriptive

Category

Phonological

Awareness 71 88* 21st Low Average

Elision 4 5 5th Below Average

Blending Words 7 10* 50th Average

Phoneme Isolation 5 9* 37th Average

Phonological Memory 67 67 1st Lower Extreme

Memory for Digits 5 5 5th Below Average

Nonword Repetition 4 4 2nd Below Average

Rapid Symbolic Naming 49 46 <1st Lower Extreme

Rapid Digit Naming 1 2 <1st Lower Extreme

Rapid Letter Naming 2 2 <1st Lower Extreme


Awareness 64 88* 21st Low Average


Segmenting Nonwords 5 7* 16th Low Average


Composite and

Subtests

Initial testing

(12/2014)

Post-Therapy

Standard or

Raw Score

Standard or

Raw Score

Percentile

Rank

Descriptive

Category

LAC-3 69 76* 5th Below Average

Isolated Phoneme


Not applicable

Tracking

Phonemes

(Monosyllables)

6/18 6/18

Counting

Syllables

(Multisyllables)

3/10 7/10

Tracking

Syllables

(Multisyllables)

1/10 4/10

Tracking

Syllables and

Phonemes

(Multisyllables)

N/A N/A


Case Study Five: S2015-Fall

7 year old male

OT – 2 hours per day, 5-days/week Language – 3 hours per day, 5-days/week

Composites and

Subtests

Initial testing

(06/2015)

Post-Therapy (9/2015)

Standard or

Scaled Score

Standard

or

Scaled

Score

Percentile

Rank

Descriptive

Category

Perceptual

Quotient 105 104 61st Average

Basic Processes 110 110 75th Average

Visual

Discrimination 18 10 50th Average

Visual Memory 10 5 5th Below Average

Spatial Relations 9 17* 99th Upper Extreme

Form Constancy 11 16* 98th Above Average

Sequencing 105 90 25th Average

Sequential

Memory 11 8 25th Average

Complex Proc. 95 100 50th Average

6 9th Below Average Figure-Ground 9

Visual Closure 9 14* 91st Above Average

TEST OF VISUAL PERCEPTION (Non-Motor) SKILLS–3rd Ed. (TVPS-3)


Initial testing

(06/29/2015)


Standard or

Scaled Score**

Standard or

Scaled

Score**

Percentile

Rank

Descriptive

Category

TOTAL MOTOR COMPOSITE 40 64* 92nd Above Average

Fine Manual Control Composite 35 55* 69th Average

Fine Motor Precision 7 18* 73rd Average

Fine Motor Integration 9 17* 66th Average

Manual Coordination

Composite 40 53* 62nd Average

Manual Dexterity 8 13* 35th Average

Upper-Limb Coordination 14 20* 84th Above Average

Body Coordination Composite 40 62* 89th Above Average

Bilateral Coordination 10 21* 89th Above Average

Balance 12 18* 73rd Average

Strength and Agility Composite 55 70* 98th Well Above Avg

Running Speed and Agility 17 21* 89th Above Average

Strength 17 26* 99th Well Above Avg

Bruininks-Osteresky Test of Motor Proficiency, 2nd Ed.

Composites and

Subtests

Initial testing

(06/2015)

Post-Therapy

(9/2015)

Standard or

Scaled Score

Standard

or Scaled

Score

Percentile

Rank

Descriptive

Category

Phonological

Awareness 103 129* 97 Above Avg

Elision 9 14* 91 Above Avg

Blending Words 10 15* 95 Above Avg

Phoneme Isolation 12 14* 91 Above Avg

Phonological Memory 104 119 90 Above Avg

Memory for Digits 14 12 75 Average

Nonword Repetition 7 14* 91 Above Avg

Rapid Symbolic Naming 92 92 30 Average

Rapid Digit Naming 8 8 25 Average

Rapid Letter Naming 9 9 37 Average


Awareness 104 137 >99 Upper Extreme

Blending Nonwords 14 18* >99 Upper Extreme

Segmenting Nonwords 7 14* 91 Above Avg


Composite and

Subtests

Initial testing

(06/22/15)

Post-Therapy

Standard or

Raw Score

Standard or

Raw Score

Percentile

Rank

Descriptive

Category

LAC-3 98 134* 99th Upper Extreme

Isolated Phoneme


Not applicable

Tracking

Phonemes

(Monosyllables)

6/18 15/18

Counting

Syllables

(Multisyllables)

1/10 9/10

Tracking

Syllables

(Multisyllables)

4/10 7/10

Tracking

Syllables and

Phonemes

(Multisyllables)

Not

administered 8/12



Initial

testing

(06/2015)


Standard

Score Standard

Score

Percentil

e Rank GE

Descriptive

Category

Total Reading 73 101* 53rd NA

Average

Basic Reading 78 99* 47th Average

Word Reading 70 96* 39th 1.8 Average

Pseudoword Decoding 85 105* 63rd 2.5 Average

Reading Comprehension and Fluency

Reading Comprehension 82 97* 42nd 2.0 Average

Oral Reading Fluency 63 75* 5th 1.0 Below Average

Oral Reading Accuracy 100 100 50th

2.0 Average

Oral Reading Rate 54 75* 5th 1.0 Below Average

WECHSLER INDIVIDUAL ACHIEVEMENT TEST- 3rd

Edition (WIAT-III)

Impaired sensory and sensorimotor processing can impact higher level cognitive and academic skills

Sensory and sensorimotor interventions can improve sensory and sensorimotor processing, supporting learning in other domains, such as language, behavior and academic skills.

Occupational Therapy IS a beneficial component of a transdisciplinary program to assess and treat sensory, motor, language, behavior, mood and attentional impairments.

Summary – from a Transdisciplinary Team Assessment & Treatment

References Alexander, A.W. (2007). Developmental dyslexia. In E. Tridas (Ed.) From ABC to ADHD (pp.57 -101). Baltimore, MD: International Dyslexia Association. Alexander, A. W., & Heilman, K.M. (2006). Treatment of developmental language disorders. Neurological Therapeutics: Principles and Practice. J. H. Noseworthy. Oxon, England, Informa Healthcare. 2: 3061-3080. Ayres, A.J. (1972). Sensory Integration and learning disorders. Los Angelos, CA: Western Psychological Services. Ayres, A.J. (1979). Sensory Integration and the child. Los Angelos, CA: Western Psychological Services. Dunn, W., Bennett, D. (2002). Patterns of sensory processing in children with attention deficit hyperactivity disorder. Occupational Therapy Journal of Research, 22, 4-15. Ghanizadeh, A. (2011) Parent reported oral sensory sensitivity processing and food preferences in ADHD. Journal of Psychiatric Mental Health Nursing, Oct 6 [Epub ahead of print] Gritter, M. (1999). Clinical forum: sensory integration therapy. Is sensory integration effective for children with language-learning disorders?: a critical review of the evidence. Language, Speech, and Hearing Services in Schools, 30, 393-400. Miller, L.J. (2011). Designing Spaces to Maximize Therapeutic Benefits. Presentation at the Sensory Processing Disorders Foundation conference, Fort Lauderdale, FL, October 20, 2011. Williams, S., & Shellenberg, S. (1994). How does your engine run? A leader’s guide to the Alert program for self regulation. Albuquerque, NM: Therapy Works, Inc.

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