- Introduction
- Cause of Concern
- Test Administered
- Result – Ayres Clinical Observations Protocol
- Result – Bruininks Oseretsky Test of Motor Proficiency
- Result – Test of Visual Perception Skills – Revised
- Conclusion
- Recommendation
There need to be a balance between the different sensory channels so that cross-sensory reference may occur, in order to provide an individual with multi-sensory information about his environment, to which he may then adapt his responses. This is sensory integration. This assessment was recommended by an educational psychologist at the beginning of Pr 6 to elucidate if my learning difficulty is sensory based.
With support and intervention over the years, my fine motor dexterity and writing have improved significantly. However, I continued to have issues with letter reversal. Other related spatial-sequencing related issues include difficulty with directionality concepts involved in mathematics and spelling.
 Correcting Confusion |
 Spelling Confusion |
With regards to attention, I continued to drift off and tired when there is competing extraneous noise. With regards to specific academic performance, she have issues coping with Mother tongue, Chinese. With remediation, I had show progress until Pr 5. At Pr 6, when oral comprehension was a bigger component of the curriculum, my result plummeted.
- Ayres Clinical Observations Protocol
- Bruininks Oseretsky Test of Motor Proficiency
- Test of Visual Perception Skills – Revised
Result – Ayres Clinical Observations Protocol
This protocol was utilized to establish baseline sensorimotor function. Areas of difficulties persisting in child’s profile were in direct relation to compromised vestibular-proprioceptive processing.
The vestibular system provides information about movement, gravity and changing head positions. Effective processing of vestibular information allow us to properly utilize our eyes, prepare our posture, maintain our balance, maintain muscle tone, plan our actions, move, calm ourselves and attend.
As it is tied to the auditory system, it also gives us the beginnings of spatial concepts. Children with no sense of space will have issues with time, sequencing and self-organisational concepts and skills. Having a sense of body and then body in space often give children the very beginnings of a reference point from which they can navigate through life motorically, socially, and cognitively. Understanding where one is in space, gives children the sense of time, direction, bilaterality, and self-organisation.
I was noted to experience difficulty in the area of bilateral coordination and sequencing and had problems performing various bilaterally involved tasks. Movement patterns during the execution of these activities were poor, impulsive and segmented. Difficulties with asymmetrical and reciprocal bilateral motor patterns were specifically challenging for me to manage. Tasks involving rhythmical and sequential movement of my upper and lower extremity and right-left coordination were all challenging for me. With sequencing, I had some difficulty coming up with the motor plan to negotiate repetitive rhythmic bilateral integration movement patterns. Often, during these tasks, I would have to visually and consciously monitor the entire sequence before coming up with a poor approximation of the stimulus sequence.
With such difficulties, it will be inherently difficult for me to perform tasks that involve sequencing, as I have to consciously attend to components of individual tasks, which for many, are semiconscious or automatic. I was found to have developed many compensatory cognitive strategies to assist me with organising information related to my studies. I had been taught mind mapping techniques which have served me well thus far in the academic setting.
Proprioceptive processing is also an area of relative weakness for me. Prioprioception is the unconscious awareness of body position. Hence, it is the proprioceptive system that gives us information about the position of our body parts, their relation to each other and their relation to other people and objects. It also allows one to grade the amount of force needed to grade our movements and allows one to make sense of touch and movement experiences. Without proper proprioceptive processing, body scheme, motor planning, and body awareness problems will be evident. During the assessment, I was noted to have difficulties indicative of poor proprioceptive functioning. Posture copying and planning motor movements were weak as I had difficulties coming up with matching postures that were bilaterally involved or postures that involved crossing my midline with gradation and with rhythm. These performances are all indicative of poor sense of body scheme affecting motor planning. Specifically noted were issues in proximal stability, midline organisation and bilateral coordination. As one’s sense of body scheme, bilateral coordination and motor planning are products of effective proprioceptive functioning, it is evident that I still struggles with my sense of proprioception.
My overall motor performance also indicated poor joint cocontraction and slightly low muscle tone. This was noted during various strength subtests. Joint cocontraction at the levels of the trunk, shoulder, and distal structures were seen. At the truncal level, I displayed difficulties maintaining the anti gravity postures of prone extension and supine flexion. For prone extension, this is needed when performing pushups. While doing this, I had a lot of accessory movements displaying a lack of proximal stability. Similarly, for supine flexion utilized in sit ups, I was seen relying primarily on fixations rather than smooth coordinated movements. From this it is evident that truncal (postural) tone is impacted. It should also be noted that difficulties in prone extension and supine flexion are often indicators that the vestibular and tactile senses, respectively, are impacted.
As development proceeds from proximal to distal, inherent difficulties proximally at the trunk will lead to difficulties at the more distal structures. With compromised stability, it is expected that fine motor dexterity will be affected. This was evident in my low scores in upper limb coordination and speed tests. In my case, stability is sought at the expense of dexterity and efficiency. It was noted that the more demand was placed on me in terms of graded control, the more I had to cope with fixations.
Result – Bruinicks-Oseretsky Test of Motor Proficiency
Noted issues in this motor proficiency test that commensurate with clinical observations of poor vestibular-proprioceptive processing include:
- Poor muscle tone impacting ability in performing strength tests
- Poor bilateral and sequencing abilities in the upper limb and bilateral coordination tests,
- Poor posture and equilibrium responses in the balance domain.
Result – Test of Visual Perceptual Skills (non-motor)
The result of the test reveal my strength in visual perception skills. This has allowed me to cope and successfully utilize compensatory learning strategies taught. However, as spatial organization and concepts are still weak at the foundational level, these strong visual perception skills still see me reversing letters at times. However, I am at a stage where I am able to recognize and self-correct.
It is evident that I still have difficulties with sensory modulation and processing. These issues have led to continued compromised spatial awareness, bilateral coordination, sequencing and balance. Motor proficiency issues have meant that I have to consciously put forth and attend to the many components that are automatic for my peers. Hence I have to work harder to stay organized and cope with the demands of schoolwork.
To assist, I was recommended a remediation program that will aid in the provision of foundational elements that will assist with my vestibular-proprioceptive processing. This will translate to better proficiency with motor skills and more importantly, better success in school.
It was further recommended that Samonas Sound Therapy (www.samonas.com) be continued to assist with processing, sequencing and spatial issues.
Another program that is also recommended is the interactive metronome program (www.interactivemetronome.com) which would assist with processing speed, bilateral integration, sequencing, timing and rhythm skill sets.