sensory processing and learning disabilities: case studies ...€¦ · sensory processing and...
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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)
EXECUTIVE FUNCTION / INTENTION
WORKING MEMORY (HOLD / MANIPULATE)
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
EXECUTIVE FUNCTION / INTENTION
WORKING MEMORY (HOLD / MANIPULATE)
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
THE PICTURE OF DYSLEXIA (ALL SYMPTOMS DO NOT OCCUR WITH EVERYONE)
ACCOMPANYING CHALLENGES (BEHAVIORAL)
Parents with similar challenges
Brain /
Behavior
Disorders
Attention & Executive
Function
Anxiety
Depression
OCD
Oppositional
Behavior
THE PICTURE OF DYSLEXIA (ALL SYMPTOMS DO NOT OCCUR WITH EVERYONE)
ACCOMPANYING SENSORIMOTOR CHALLENGES
Up/Down
Left/Right
Oral Motor Messy Eating
Writing/knots Fingers
Eyes
Tired
Words Swim
Lose Place
Spatial Awareness
THE PICTURE OF DYSLEXIA (ALL SYMPTOMS DO NOT OCCUR WITH EVERYONE)
Praxis
Disciplines:
Neuropsychology
Psychiatry
Clinical Psychology
Occupational Therapy
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)
Occupational Therapy
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
Composites and Subtests
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
COMPREHENSIVE TEST OF PHONOLOGICAL PROCESSING-2ndEd
Composites and Subtests
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
Alternate Phonological
Awareness 79 113* 81st High Average
Blending Nonwords 6 9* 37th 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
Patterns 15/16 16/16
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)
Composites and Subtests
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
Alternate Phonological
Awareness 64 88* 21st Low Average
Blending Nonwords 3 9* 37th Average
Segmenting Nonwords 5 7* 16th Low Average
COMPREHENSIVE TEST OF PHONOLOGICAL PROCESSING-2ndEd
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
Patterns 16/16 16/16
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
LINDAMOOD AUDITORY CONCEPTUALIZATION TEST, 3rd ED
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)
Composites and Subtests
Initial testing
(06/29/2015)
Post-Therapy (9/2015)
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
Alternate Phonological
Awareness 104 137 >99 Upper Extreme
Blending Nonwords 14 18* >99 Upper Extreme
Segmenting Nonwords 7 14* 91 Above Avg
COMPREHENSIVE TEST OF PHONOLOGICAL PROCESSING-2ndEd
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
Patterns 15/16 16/16
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
LINDAMOOD AUDITORY CONCEPTUALIZATION TEST, 3rd ED
Composites and Subtests
Initial
testing
(06/2015)
Post-Therapy (9/2015)
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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