The use of Ayres' Sensory Integration and the Sensory Integration & Praxis Tests (SIPT) is a hot topic in school districts across the nation. More and more parents are requesting it and thus more school districts are looking for occupational therapists that can administer the SIPT and provide a sensory integration model of therapy.
In fact, searching for School-based OT jobs on Edjoin.org you will often find a description that looks a little like this:
So what are your options when it comes to gaining knowledge about sensory integration? If you have worked in a pediatric setting of any kind, you have no doubt picked up at least some sensory-based strategies as well as some theory on SI.
The University of Southern California Sensory Integration courses cost thousands of dollars and at conferences such as AOTA, you can attend seminars to get small snippets of sensory integration techniques from various OTs. And a google search of "what is sensory integration" yields an endless amount of professional organizations that attempt to provide the definition in a way that parents will want to seek it out for their child. Not to say that parents shouldn't seek SI out, but it is not exactly the information an OT might be looking for.
As far as the Sensory Integration and Praxis tests goes, in this post I wanted to give you a brief overview of the 17 (yep, 17) individual tests that make up the SIPT
While long and exhaustive, I must say I appreciate how the SIPT is composed of individual tests that are each norm-referenced. Unlike the BOT-2 where you get a standard score for a group of tests related to visual-motor integration, the SIPT provides you with a score for each separate test.
The 17 tests that make up the SIPT
1.Space Visualization
This first test reminds me of a toy you might find on Amazon. It consists of 2 plastic form boards with a peg that can be moved so that only a certain form can fit correctly into the form. for each form board, there are 2 corresponding forms (an egg shape and diamond shape) with a hole in each shape for the peg to fit into when correctly placed into the board.
On this test, you record the accuracy of choosing the correct form, the hand used by the child to pick up the form, and the time taken for the student to pick which form they think will fit.
As you can likely imagine, this test looks at a child's ability to visualize in their head which form will correctly fit. It is also measuring, however, the ability to cross the midline and unofficially the handedness of the student.
2. Figure-Ground Perception
Similar to other visual perception tests commonly used, the figure-ground test looks at a child's ability to find the pictures/shapes hidden within a larger picture. The student is instructed to identify the 3 out of 6 options that are hidden in the larger picture. Along with accuracy, the time to process each answer is also recorded for this test.
3. Standing and Walking Balance
Just as the name indicates, this test looks at a child's ability to balance in various static and dynamic positions with their eyes open and then closed on most items. A wooden dowel (shaped like a tine speed bump) is used as a way to measure balance on a stationary raised object.
Much of sensory integration is based upon the proprioception and vestibular senses, both of which assist us every day to stay on our feet or seated upright in our chair.
4. Design Copy
This is the SIPTs version of a visual motor integration test such as the Berry VMI. What I really like about the Design Copy test is how it's scaffolded. The child starts by connecting dots in a horizontal and vertical line on a dot plane, then the dots from the stimulus image disappear. Finally, all of the dots disappear and the drawing becomes even more intricate.
This test is graded on several "should have (SH)" and "should not have (SNF)" factors including line deviation, mirror or flipped drawings, and where the child starts the drawing.
Think of it as objectively measuring all the nuances that you take notes on while watching your student try to draw the overlapping pencils on the BOT-2
5. Postural Praxis
One of the more fun test, but also more difficult to grade, is the postural praxis test. During this test, the assessor assumes a not so normal position, and the child aims to mimic the body position they see in front of them.
A child is given full credit if the correct position is assumed in 3 seconds or less, partial credit if within 7 seconds, and no credit beyond that. This test can reveal much more than you would think.
6. Bilateral Motor Coordination
You likely do this one with your kids already, but here it is standardized. In this test, the student mimics your 4-8 steps bilateral drumming patterns. After your done with the hands, move on to the feet.
This assessment is based upon a 3-point scale; incorrect, approximately correct, or correct.
7. Praxis on Verbal Command
As the name suggests, this test is looking at how the child responds to you giving them a 1-2 step verbal direction. An example is "Put the back part of your feet together and your toes apart."
For this test, you simply grade whether it was correct or not, and how long it took to get there (up to 15 seconds).
8. Constructional Praxis
This test and the Postrotary Nystagmus test are the two tests I think people most associate with the SIPT.
The constructional praxis test includes a prebuilt "fort," for lack of a better word, and the blocks needed to recreate that fort. The assessor then helps the child to get started with the building and then allows the child up to 15 minutes to complete the structure.
This is probably the most difficult test to score as you have to measure each of the 15 blocks against 8 different criteria. Grading this block fort is an assessment in itself for an assessor.
9. Postrotary Nystagmus
A classic part of the SIPT, the Postrotary Nystagmus test involves spinning the child on a spin board 10 times over a period of 20 seconds with their eyes open. after ten turns, you look at and time how long the nystagmus reaction occurs.
For the SIPT, the norm reference for how long this reaction should occur after being stopped is 10 second with a small room for error.
Precaution: It a child has a history of seizures, you may not want to administer this test. be sure to complete a chart review and/or ask the child's doctor for any precautions. changes in light while spinning can cause the onset of a seizure.
10. Motor Accuracy
For this test, the child traces over a black line that spans over a construction sheet sized paper (11"x17" I think). The line is wavy in nature and it does not cross at any time like a figure-8 does. The child attempts the task first with their dominant hand, and then again on the backside of the sheet with their non-dominant hand.
This test is scored by the time it takes to complete the task, and by using a rolling measuring tool to see how frequently the child stayed on the black line or within a given area.
It's always interesting to compare the dominant hand trial versus the second trial. If they look the same, it's probably not a good sign...
11. Sequencing Praxis
Similar to the Bilateral Motor Coordination test, on this test the child mimics your hand "clapping" sequence. This time, however, each step builds upon the previous step. For example, I clap twice then the child claps twice. Next, I clap twice then knock the table, child mimics. Now I clap twice and knock the table twice... and so on. This continues on until it becomes a 6-step process.
Along with full hand gestures/taps, this test goes on to include finger taps as though you were typing. Ex. index, middle, index.
12. Oral Praxis
Another fun one, in this test the assessor does something with their tounge, lips, teeth or combination of those and the child mimics.
Two examples include "put tongue in left cheek" (assessor does this then child mimics) and "smack lips"
Score as an incorrect (o), poor quality (1), or well executed (2).
If you have already, please give your eyes a break from reading this.
If you have read this far, you may like to know that I produce a podcast with my partner in crime, Abby Parana, all about Pediatric OT.
Alright, back to the SIPT. 5 more to go
13. Manual Form Perception
The Manual Form test is a clever one. With their eyes occluded, the child is first asked to find a shape described by yourself. After that, they are to feel a shape with one hand and find that same shape with their other hand.
Some shapes are very different, while others are very similar. The hardest part for you on this test is holding the folder to block the child's vision while timing them. Good luck.
14. Kinesthesia
Another clever one with the child's vision blocked. The child starts with their index finger on point "A". You then move their hand and finger to point "B" then back to point "A".
It is then their job to try and move their finger back as close as they can to point "B" on their own volition without looking.
You find out a lot about a child's body awareness through this test. This is something you could do in just a few seconds without the SIPT and I don't use it nearly as much as I should.
15. Finger Identification
Again, with the child's vision occluded, the assessor taps on one or two fingers of the child's hand and then the child identifies which finger or fingers were touched. This is simply scored as a "0" or a "1" if correct. We are mostly checking to make sure the tactile system in all okay here.
16. Graphesthesia
For this test, you draw a design on the back of the child's hand with your finger while the child cannot see. You then see if the child can recreate the design with their own finger. So you occlude the child's vision while you draw the design, then they are allowed to look while they draw the design. Designs vary from a straight line to a simple star.
17. Localization of Tactile Stimuli
And the last one, LTS! For this test, we use a special pen to mark a spot on the child's arm or hand with their vision occluded and then they touch that spot with their vision still occluded. Again, this gives you a good insight to the child's body awareness.
WOW, that was all 17!
This is not a short set of tests by any means. On the few occasions that I have given the SIPT, it has taken two-to-three sittings of at least an hour each. That is the main reason I don't use it more frequently. The scoring is also time-consuming and requires a computer software and USB key to get the final results.
The best administrators of the SIPT say they can get it done in a single 90 sitting. Of course, it really depends on the child as well.
To wrap this up, I am SIPT certified and I completed the WPS/USC training about 4 years ago. It has since been discontinued. USC now offers a series of courses that can be taken in southern California, but they are costly. I recommend them if you are interested in getting a deep dive into sensory integration.
I hope this intro to the Sensory Integration and Praxis Tests gets you interested in learning more at least.
If you have any questions, feel free to email me!
Until next time,
Jayson
