Transcript Sensory and Motor

Assessment of Vision,
Hearing, Health, Sensory
and Motor
Vision Screening and
Assessment
• Schools must state pass/fail criteria for
vision screening in the district
compliance plan.
• Criteria for diagnosis of partially
sighted states a central visual acuity
range of 20/70 to 20/200 in the better
eye with best correction.
Vision Must Be Evaluated
Some individuals with ASD may
not respond to the typical
screening instruments
Vision Screening…con’t.
• Criteria for blind states 20/200 or less in
the better eye after best correction.
20/20 indicates a person can see a
standard sized object for a standard
number of feet away. A person can, for
example, distinguish a letter or number
at 20 feet that an average person can
distinguish at 20 feet.
• 20/200 indicates a person can
distinguish at 20 feet what the average
person can distinguish at 200 feet.
Visual Impairment
• May have normal central vision
(acuity) with deficits in peripheral
field (tunnel vision).
• Color Blind – Usually not all or
nothing; may perceive different
hues. Inherited trait.
What Tests are Most
Common?
• VISION: Snellen Chart, Titmus, Keystone
• HEARING: Beltone Audiometer
• MOTOR:
*Bender Visual Motor Gestalt Test
*Developmental Test of Visual Motor
Integration 4 (VMI), DTLA-4
* Bruiniks-Oseretsky Test of Motor
Proficiency
* Motor Free Visual Perceptual Test
Snellen Chart
A Snellen chart is an eye chart used by
eye care professionals and others to
measure visual acuity. Snellen charts
are named after the Dutch
ophthalmologist Herman Snellen who
developed the chart in 1862. 
Titmus Vision Screener
The Titmus 2s Vision Screener is an instrument that
can test for binocularity, visual acuity, color and
depth perception and vertical and lateral phorias.
the T2s model with perimeter can also test for
peripheral vision in the horizontal field.
Tests for acuity near, far, color,
binocular functioning, and depth.
Keystone
The Keystone Ophthalmic Telebinocular
is the accepted pioneer instrument of
modern binocular vision testing and
training.
Vision…con’t.
Functional vision assessment –
Response to environmental
stimuli, colors, photographs,
line drawings, details in the
environment.
Visual Behaviors
1) Close scrutiny of visual details
2) Prolonged staring
3) Over/under response to visual
cues
4) Lacks visual attention
5) Poor eye/face regard
What Tests are Most
Common?
• VISION: Snellen Chart, Titmus, Keystone
• HEARING: Beltone Audiometer
• MOTOR:
*Bender Visual Motor Gestalt Test
*Developmental Test of Visual Motor
Integration 4 (VMI), DTLA-4
* Bruiniks-Oseretsky Test of Motor
Proficiency
* Motor Free Visual Perceptual Test
Hearing Must Be
Evaluated
Hearing:
Tests such as audiograms and
tympanograms can indicate if a child has a
hearing impairment. Audiologists, school
nurses and educators can evaluate the
functional hearing of individuals by
measuring responses such as blinking or
staring or turning the head when a light is
presented and response to environmental
stimuli.
Hearing Screening and
Assessment
• Schools must state pass/fail criteria for
hearing screening in the district
compliance plan.
• ASHA (1985) recommends failure of
pure tone hearing screening when
individual fails to respond to screening
levels presented in either ear.
Hearing
Screening…con’t.
• ASHA has recommended for screening
using frequencies of 500, 1000, 2000
and 4000 HZ at a HL of 20 DB.
• Hearing speech sounds in range of 500
to 4000 crucial to understanding
conversational speech.
• ASHA regards 20 DB as upper range of
normal hearing for children.
Hearing…con’t.
• Screen for failure in either ear after 20
DB
• Rescreen if failure, more complete
functional hearing assessment –
audiogram or Tympanometery
(screening of middle ear or eardrum)
conducted by an audiologist.
Beltone Audiometer
Auditory Behaviors
1) Non/over response to varying sounds;
response to same sound may change
over time
2) Seems not to hear
Medical Assessment
Assessment based on screening
information, in depth social and
developmental history.
Medical tests are not required for an
educational diagnosis of autism; however,
screening may warrant medical referral
due to concomitant conditions and a
detailed medical history and current health
status is required.
Medical Assessment
• Metabolic Screening: Blood and urine lab
tests measure how a child metabolizes
food and its impact on growth and
development.
• Magnetic resonance imaging (MRI):
Magnetic sensing equipment creates, in
extremely fine detail, an image of the
brain.
(Sicile-Kira, 2004)
Medical Assessment
Computer-assisted axial tomography
(CAT scan):
CAT scans are useful in diagnosing
structural problems in the brain by
taking thousands of exposures which
are then reconstructed in great detail.
(Sicile-Kira, 2004)
Medical Assessment
• Genetic testing:
Blood tests can show abnormalities in the
genes that could cause a developmental
disability.
• Electroencephalogram (EEG):
An EEG can detect tumors or other brain
abnormalities. It also measures brain
waves that can show seizure disorders.
(Sicile-Kira, 2004)
Sensory
• Sensory input vision and hearing
• Sensory integration (OT assessment)
• Fine and Gross Motor
Sensory and Motor
• Sensory differences are often
an indicator of autism. Absence
of differences does not
necessarily mean that it is not
autism.
Sensory and Motor
• Consider and handle Motor
skill assessment as you
would any other student with
suspected deficits in that
area.
Sensory and Motor
• Before the Review of Existing Data
(RED)
*Contact your OT
*Complete the paperwork for a
screening
Who Should Assess Sensory
and Motor?
Trained Professionals:
*Occupational therapist, physical
therapist, adaptive PE and regular PE,
nurse, medical professionals.
Certain Procedures and instruments:
*Speech and language clinicians,
trained educational professionals.
Sensory Assessments
• Sensory Profile – School Companion
--Important for students when Autism is
suspected
--Filled out by one or two school team
members
--Scored and interpreted by an OT
Sensory Systems
Involved
• Tactile Behaviors
1. Hypo/hyper response to touch and
temperature
2. Unusual response to pain stimuli
3. Self-injurious behavior
Sensory Systems
Involved
• Olfactory Behaviors
1. Smells objects/repetitive sniffing
2. Licks inedibles
Sensory Systems
Involved
• Vestibular Behaviors
1.Over/under response to gravity stimuli
2.Whirling without dizziness
Sensory Systems
Involved
• Use of Objects
1.May use objects inappropriately
2.May become fascinated with parts of
objects
3.May engage in ritual behaviors
(spinning, arrangements of objects, etc.)
4.May form attachments to unusual
objects such as sticks or string
Sensory Systems
Involved
Stereotypic Behaviors
1.May engage in unusual body posturing,
finger flicking and toe walking
2. May use repetitive, stereotypic words
and phases
These examples are only a
partial listing of possible referral
characteristics and are not
intended to provide an
exhaustive list.
Motor Assessments
• Typical assessments for any student with
fine motor concerns:
--Bruininks-Oseretsky Test of Motor Proficiency
--Follow the advice of the OT
--Fine motor observation done by the OT would
be good for initial evaluation for Autism
--OT will help support educational impact of
sensory/motor differences (if there are some) in
her observational report.
Connections to Other
Disciplines
• Sensory differences should be
documented throughout the evaluation
report. Possible places include:
- Classroom observations
-Observational notes during formal
assessments
- Student history
-GADS, GARS, ASDS, etc.
What are Current Dilemmas in Sensory,
Motor, and Sensorimotor Assessment?
• Assessment does not always generate
effective information for programming
and therapy. Particular difficulty is
noted with assessment of perceptual
skills and the relationship of perceptual
assessment to educational
programming.
What are Current Dilemmas in Sensory,
Motor, and Sensorimotor Assessment?
• Serious concerns are noted
with technical adequacy of
standardized tests,
particularly with validity of
perceptual tests.
What are Current Dilemmas in
Sensory, Motor, and
Sensorimotor Assessment?
• Trained professionals are not always
available in school districts.
• Lack of training, understanding in
regard to relationship of sensory and
motor problems to academic difficulties.
What are Current Dilemmas in
Sensory, Motor, and Sensorimotor
Assessment?
• Sensory and motor deficits may
adversely affect performance in
assessment.
• Score and results may not be
conducted outside of the educational
setting and results may not be shared
with educational professionals.
What are Solutions to the Dilemmas
in the Areas of Sensory and Motor
Assessment?
• Supplement results with standardized testing
with informal/authentic and functional analysis.
• Relate programming and therapy decisions to
behavior manifestations and environmental
analysis of perceptual motor and sensory
deficits. Conduct systematic observation across
natural environments.
What are Solutions to the
Dilemmas in the Areas of Sensory
and Motor Assessment?
• Be sensitive to sensory and motor
problems in assessment planning, select
instruments and procedures that will as
much as possible reflect ability.
• Provide appropriate assistive technology in
the assessment process and include in
your assessment an analysis of assistive
technology needs.
What are Solutions to the
Dilemmas in the Areas of Sensory
and Motor Assessment?
Coordinate assessment and
instructional planning efforts.
Obtain outside medical evaluations.
Communicate with medical
professionals outside the
educational system.
What are Solutions to the
Dilemmas in the Areas of Sensory
and Motor Assessment?
Have OT, PT, nurse and speech and
language clinicians conduct
assessment in natural classroom,
school, home and community
environments including systematic
observation of the individual in
those environments.