Screening Sensorimotor

Chapter 9. Screening, Evaluating, and Assessing Children with Sensorimotor Concerns and LinkingFindings to Intervention Planning: Strategies for Pediatric Occupational and Physical Therapists 185

As noted in Chapter 8 (this volume) byWilliamson, Anzalone, and Hanft, pediatricphysical therapists and occupational therapistshave traditionally measured the skills of youngchildren and provided intervention to them inthree areas of development: sensory process-ing, praxis, and motor performance, each ofwhich contain specific elements (see Table 1).

In the past, therapists have used evalua-tion, assessment, or screening findings to

make decisions regarding the status of a childand to develop intervention plans. Oftenthese decisions were made independently offindings from other professionals or withoutparental input. However, during the last 20years, there have been significant changes inhow therapists view their role in the measure-ment and intervention process. Three factorshave influenced these changes.

First, public policy and legislative initia-tives have required therapists and other pro-fessionals to reassess basic methods ofcollecting developmental or behavioral infor-mation. The passage of Part B (PL 94-142) ofthe Individuals with Disabilities EducationAct (IDEA) in 1975 required therapists work-ing in educational systems to serve childrenwithin an educational framework, work in amultidisciplinary team, and recognize theinter-relatedness of motor skills to otherareas of development. In 1986, Part H1 ofIDEA (PL 99-457) expanded services to

9

Screening, Evaluating, and Assessing Children withSensorimotor Concerns and Linking Findings toIntervention Planning: Strategies for Pediatric

Occupational and Physical Therapists

Toby M. Long, Ph.D., P.T., and Kirsten M. Sippel, M.P.P., P.T.

Table 1. Elements of SensorimotorDevelopment

Areas ElementsSensory processing Modulation

PerceptionDiscrimination

Praxis IdeationMotor planningExecution

Motor performance NeuromotorFine motorGross motorOral motor

1The 1997 Reauthorization of IDEA realigned the Act:Part H is now called Part C. In further discussion in thischapter, the early intervention component of IDEA isreferred to as Part C.

ICDL Clinical Practice Guidelines186

infants and young children and mandated thatservices be delivered in a family-centeredmanner. Therapists broadened their systemsand strategies of gathering information abouta child’s performance and providing servicesto include collaboration with the family andother team members. Contemporary evalua-tion and assessment strategies, as well asintervention, how support collaborationamong team members and the family, inte-gration of findings across domains and envi-ronments, and the reporting of findings in afamily-centered, culturally sensitive manner.

Second, research during the last 20 yearshas clearly indicated that the areas of devel-opment typically measured in a young child(e.g., behavior, motor, language, and cogni-tion) are interdependent (Greenspan &Meisels, 1993). Biological, cultural, andenvironmental variables are recognized tosupport, facilitate, or impede the develop-ment of infants and young children. For ther-apy to be meaningful, therapists must notonly be knowledgeable in how neuromotordevelopment occurs but also in how it may beaffected by sociocultural and environmentalparameters. For example, muscle tone in adeveloping child may be affected if a care-giver does not encourage independent move-ment or holds or positions a child in certainways (Cintas, 1995). Additionally, cognitiveskills are enhanced if a child moves inde-pendently within the environment (Berenthal,Campos, & Barrett, 1984).

The third factor that has influenced themeasurement process, the development ofmeasurement instruments, and therapeuticintervention is the application of the dynam-ic systems perspective of motor development(Case-Smith, 1996; Piper, 1993). Traditionalmeasurement instruments used by therapistsare based on the neuromaturational theory ofmotor development advanced by McGraw(1945) and Gesell (1945). Early therapeutic

strategies also used the neuromaturationaltheory as a framework. The neuromatura-tional theory is based on the assumption that,as the central nervous system matures, motordevelopment will proceed in a hierarchialfashion. Accordingly, development occurs ina cephalocaudal and proximal-distal direc-tion at a specific rate. As the infant develops,higher centers of the central nervous systeminhibit lower centers so that voluntary move-ments can occur when reflexes are integrated.

Dynamic systems theory views the devel-opment of motor skills as emerging from theinteractions of many subsystems within a spe-cific task (Heriza, 1991). These subsystemsinclude the musculoskeletal system (jointmobility, muscle strength, and static posturalalignment), movement patterns (motor mile-stones, reflexes and reactions, coordination,balance, and endurance), functional perform-ance, sensation (visual, vestibular, proprio-ceptive, auditory, and tactile), and perception.According to Heriza (1991), an assessmentfollowing a dynamic system paradigm shouldidentify age-appropriate tasks, transition peri-ods, the subsystems impacting movement,and contextual variations.

Chapter 8 provided a review of many toolsavailable to pediatric physical therapists andoccupational therapists to gather informationregarding a child’s sensorimotor development.The components of sensory processing, prax-is, and motor development also are described.The authors have stressed the need to includeparental interview and child observation aspart of a comprehensive assessment strategy.The purpose of this present chapter is to pro-vide a framework that will assist therapists inchoosing the most appropriate measurementmodel and instrument for children with sen-sorimotor and sensory-processing concerns.Additionally, intervention models andapproaches will be reviewed.

Chapter 9. Screening, Evaluating, and Assessing Children with Sensorimotor Concerns and LinkingFindings to Intervention Planning: Strategies for Pediatric Occupational and Physical Therapists

THE MEASUREMENT PROCESS

This chapter presents a general discussionof the similarities and differences among theprocesses of screening, assessment, and evalu-ation, followed by descriptions of five modelsused by therapists to gather information forclinical decision making. Additionally, severalmeasurement instruments are described.These instruments were chosen because oftheir unique contributions to the processes of(a) identifying infants and toddlers who mayhave a developmental problem, (b) predictingwhich infants will continue to demonstrateproblems throughout childhood, or (c) docu-menting change in the acquisition of develop-mental or functional skills or change in theperformance of existing skills. A chapterappendix lists several additional instrumentsnot discussed here or in Chapter 8 that are alsoavailable to therapists.

Purpose of Measurement

Measurement is the process of describingcharacteristics of an individual by gatheringinformation in an organized manner. A varietyof methods are used to gather information,including (a) interviewing parents and otherprimary caregivers, teachers, and health pro-fessionals involved in the care of a child, (b) observing the child in natural settings, and(c) direct testing of the child. Measurement isconducted for seven purposes, as shown inTable 2. The procedures, strategies, and typesof tests chosen as measurement tools will bedriven by the purpose of measurement andwhat type of information is needed.

The IDEA defines evaluation, assessment,and screening as they relate to early interven-tion and educational programs (IDEA, 1997).The screening process is used to detect if achild’s behavior or skill development is at alevel that places the child at risk for a

developmental problem, concern, or delay.The screening process should be brief and thetest used should be easy to administer by avariety of people (physicians, therapists, nurs-es, teachers, and in some cases, parents). Toincrease the likelihood that screening takesplace on a regular and consistent basis, theprocedure should be designed to be used inpediatricians’ offices, classrooms, and com-munity-based health and social service agen-cies, or on an out-patient basis. Additionally,screening instruments should be reliable andaccurate (Gilbaide, 1995).

The evaluation process is more complex.Evaluations are used to help make a diagnosis,identify atypical development, or determineeligibility for services. Instruments used aspart of an evaluation process are usually norm-referenced, standardized tools. Many of thetests measure a single developmental area,such as motor or language (Taylor, 1993), butothers are comprehensive developmentalscales covering more than one area of devel-opment. Evaluation methods include whatKirshner & Guyatt (1985) refer to as a “dis-criminative index.” A discriminative index dis-tinguishes between individuals or groups onspecific dimensions, such as the acquisition

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Table 2. The Purposes of Measurement

Purpose Strategy

Identify risk Screening

Diagnose Evaluation

Determine eligibility Evaluation

Plan intervention Assessment

Determine change in functioning Assessment

Determine efficacy of intervention Assessment

Research Evaluation

ICDL Clinical Practice Guidelines

of developmental milestones. Discriminativemeasures are often used to determine if achild’s behavior is typical for her age and areused to determine eligibility for services.Many of the tools traditionally used by thera-pists, such as the Bayley Scales of InfantDevelopment-II and the Peabody Develop-mental Motor Scales, fall into this category.

Physical and occupational therapists aremost often involved in the assessmentprocess. Assessments often use comprehen-sive tools to delineate strengths and needs,develop appropriate intervention plans andstrategies, and determine change in individualchildren. An assessment is most meaningfulwhen it represents the child’s typical perform-ance (Shelton, 1989). Thus, the assessmentprocess should gain information regarding thechild’s abilities and behaviors across domainsand environments (Cicchetti & Wagner,1990). Assessments use a variety of methodsto gather information. Norm-referenced andcriterion-referenced instruments are com-monly used. The assessment process alsogains valuable information through ecologicaland performance appraisals (portfolios). Theemphasis in an ecological approach to assess-ment is on documenting the child’s success inparticipating in activities and routines acrossdomains and environments. The assessment isconducted in the child’s natural environment;thus, the skills demonstrated also reflect thecontext of performance. Judgment-basedassessments document the parents’ and care-givers’ perceptions of a child’s performance.According to Kirshner and Guyatt (1985), anassessment can be “evaluative.” An evaluativestrategy is one that measures the magnitude ofchange in an individual over time on a specif-ic dimension. The overall purpose of anassessment is to describe a child’s strengthsand needs to help design appropriate, individ-ualized therapeutic intervention plans.

Approaches to Measuring Skills

In addition to classifying testing instrumentsaccording to their purpose, tools available totherapists can be classified according to how theinformation is obtained: informally, formally,or ecologically. Informal strategies gatherinformation in a less structured format. Facilityor therapist-made checklists, developmentalskill level forms, and interviews are examplesof instruments that obtain information infor-mally. Informal measurement strategies areeasy to administer, are flexible to meet a fami-ly’s needs and schedules, and will often obtaininformation on the typical performance of thechild. The information provided can be gath-ered by observation or through caregiverreport. Due to the flexibility inherent in theinformal classification, rigorous testing proce-dures that increase reliability and validity areoften missing. However, using informal proce-dures initially will establish rapport with thefamily and delineate parental concerns.

Therapists are most familiar with formalmeasurement strategies. Norm-referenced, cri-terion-referenced, and curriculum-based meas-urement instruments are included in the formalclassification. Formal strategies are most oftenused to discriminate those children who areshowing atypical development or delays. Twoadvantages of formal instruments include anestablished criteria, and standardized adminis-tration and scoring procedures that increase thereliability, validity, and accuracy of the instru-ment. A commonly cited limitation of formalinstruments is the lack of familiarity betweenthe examiner and the child, which may limit thechild’s willingness or ability to demonstrate hiscapabilities (Greenspan & Meisels, 1993).Additionally, most formal tests do not take intoconsideration the context of performance. TheBayley Scales of Infant Development-II(Bayley, 1993) is an example of a formal, dis-criminative tool.

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Ecologically based or naturalistic strategiesare becoming more accepted by professionalsas accurate methods to gather informationregarding a child’s behavioral repertoire.Ecologically based measurement strategies aredesigned to determine a child’s ability to per-form a functional activity rather than the child’scapability to perform a skill. Ecologically basedprocedures take into consideration the physical,social, and psychological environment in whicha task is performed. An ecological or naturalis-tic assessment provides qualitative and quanti-tative information about the child. Observingthe child within the environment in which askill needs to be performed increases the likeli-hood that the therapist will gain meaningfulinformation. Also, naturalistic assessmentsprovide opportunities for self-initiation, choice,and problem solving by the child. (SeeWilliamson, Anzalone & Hanft, Chapter 8, thisvolume.) These capacities often are notobserved during structured, formal testing.Evaluation or assessment strategies such asthe Alberta Infant Motor Scale (AIMS) (Piper& Darrah, 1993), the Toddler and InfantMotor Development (TIME) (Miller & Roid,1994), the Functional Outcome AssessmentGrid (Campbell, 1993), and the SchoolFunction Assessment (SFA) (Coster, Deeney,Haltiwanger, & Haley, 1998) are consistent withthe ecological classification, incorporatingobservation, family participation, and task-spe-cific activities into the evaluation or assessmentformat. The ecologically based strategy is con-sistent with the contemporary view of motordevelopment, recognizing the importance ofcontext, task, and family or caregiver participa-tion (Heriza, 1993; Gentile, 1987; Lyons,1984). The naturalistic process emphasizesadaptive behavior and yields a description of achild’s repertoire of behavior across skilldomains. This type of measurement approachcan be linked directly to program planning andis used primarily for assessment purposes.

Models of Measurement

This section discusses five models usedto gather information about a child’s sensori-motor performance. The bottom-up model isprimarily used for evaluation purposes. Threeof the models—top-down, routines-based,and arena—are more applicable for assess-ment procedures. The fifth model—thejudgement-based approach—is used for bothassessment and evaluation.

The Bottom-Up Model Traditionally, therapists rely on a bottom-

up perspective (see Figure 1a) to gather infor-mation about a child’s motor performance(Campbell, 1993). The bottom-up perspec-tive is a diagnostic prescriptive model wheredeficits are delineated in specific areas and aprogram is designed to remediate thosedeficits. This model is most appropriate for(a) evaluation, and (b) when designing inter-ventions targeting impairments such asdecreased joint range of motion or muscleweakness. This model is less helpful whendesigning functionally oriented interventionplans needed in early intervention and educa-tional programs.

The Top-Down Model As noted previously, assessment proce-

dures are most often used for program plan-ning. Therapeutic programs for children arefunctionally oriented and are geared to theaccomplishment of outcomes. In the top-down model (see Figure 1b), desired out-comes guide the assessment process.Desired outcomes are statements thatdescribe what the team (parents, caregivers,and professionals) would like to see happenwith a child. Outcomes can be general (“I’d liketo see Anna move around”) or specific (“Ryanneeds to walk from the bus to the classroom”).Assessment procedures that operationalize the

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top-down approach answer the following spe-cific questions (Campbell, 1993):• What environmental factors and/or per-

formance components are interferingwith or facilitating a child’s performanceof the desired outcome?

• Into what specific objectives can the out-come be divided to minimize the immedi-ate and long-term negative effects ofidentified interferers?

• What intervention approaches, models,and strategies will be used to promoteimmediate and long-term attainment ofthe desired outcome?

Currently, there are only a few tools avail-able that operationalize the top-down approach.Thus, research related to the rigor of these toolsis lacking.

The Routines-Based Model As part of the family-centered interven-

tion planning process, McWilliam (1992) pro-moted the routines-based model ofassessment. Consistent with the top-downapproach, a routines-based assessment modeljudges the capabilities of the child withineveryday routines and activities. A routines-based assessment identifies those factors(child-specific and environmental) thatinterfere with or promote the performance ofa specific functional task within a specificroutine. For example, a therapist would assessa child’s stair-climbing ability while the childis ascending stairs to go to his bedroom totake a nap or descending stairs to the base-ment playroom to obtain a toy, and wouldassess how a child scoops with a spoon duringsnack time. The use of routines to assess

Figure 1. The Top-Down and Bottom-Up Approaches to Assessment

TOP-DOWN APPROACH

DESIRED OUTCOME

BOTTOM-UP APPROACH

Identificationof Interferers

Identificationof Strengths

Strategies to Bypass Interferers

Determine Goal

Identify Strengths,Weaknesses, Deficits

Strategies toImprove Performance

INTERVENTION PLANOBJECTIVES AND STRATEGIES

ASSESSMENT

ASSESSMENT

ASSESSMENT

DESIGN INTERVENTION PLAN,GOALS, OBJECTIVES AND STRATEGIES

1a. 1b.


behaviors is helpful for program planningbecause:• Routines are meaningful to parents and

caregivers• The use of routines promotes the delin-

eation of functional outcomes and inter-vention strategies

• Observation of a child across domains,contexts, and environments is most effi-cient when it involves naturally occurringroutines

As noted in the top-down approach, theroutines-based approach has strong clinicalsignificance but lacks research supportingits use.

Arena AssessmentThe arena assessment, primarily used in

early intervention, is the simultaneous obser-vation of a child by specialists in various dis-ciplines. The purposes of an arena assessmentare to:• Obtain an integrated, holistic view of the

child• Determine the interrelationship of skills

across domains• Decrease handling of the infant/toddler

by multiple professionals• Decrease repetitive questioning of the

family

The arena assessment consists of fivecomponents (see Box 1) (Foley, 1990).

The arena assessment can streamline casemanagement and promote integrated servicedelivery. The arena assessment, however, canbe time consuming. In order for all membersof the team to gain the information they need,preassessment planning is needed. Also, themodel requires a great deal of collaborationamong team members.

Judgment-Based AssessmentThe judgment-based assessment format

enables therapists to obtain task-specificinformation about a child from thoseindividuals who observe the child’s per-formance on a regular basis. Thus, askingparents and caregivers to fill out a form oranswer a series of questions regarding thechild’s behavior would yield informationthat parents and caregivers (a) find mean-ingful, and (b) consider typical behavior forthe child.

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Box 1. Components of anArena Assessment

Team: Multidisciplinary team wheremembers are determined from thedesired outcomes. Team membershipwill vary across children depending onpurpose of assessment.

Facilitator: The individual team mem-ber who interacts with the child. Thefacilitator is usually determined by theteam based on the needs of child, pur-pose of assessment, and family desires.

Process: The process is family drivenand naturalistic. Although the processmay vary depending on the needs of thechild and family, it should obtain infor-mation on the physical, social-emotion-al, and psychoeducational capacities ofthe child.

Staffing: A working meeting in whichthe team (which may include the family)synthesizes and analyzes the informa-tion gained from the assessment.

Outcome: A thorough arena assessmentshould yield a qualitative and quantita-tive description of the child, delineatingstrengths and needs.


Measurement Instruments

In Chapter 8, Williamson, Anzalone, andHanft discuss many tests used to directlyevaluate or assess children on motor per-formance, sensory processing, and praxis. Toavoid redundancy, the following section dis-cusses only those tools that are specific toneuromotor and/or functional performance,and that are designed specifically to assistwith program planning and documentingchange over time. Additionally, all these testshave been specifically designed to capture aunique aspect of performance administeredin a manner consistent with contemporaryviews of motor development, motor perform-ance, and functional outcome.

Alberta Infant Motor ScaleThe Alberta Infant Motor Scale (AIMS)

(Piper & Darrah, 1993) was designed to iden-tify infants up to 18 months of age who havegross motor delays. It can be used as a screen-ing tool or as part of an assessment to meas-ure gross motor skill maturation over time.The authors of the AIMS clearly indicate thatthe test should not be used for older childrenwith known disabilities who are functioningbelow the 18-months-old level or to monitorprogress of therapy in children with knowndisabilities. The AIMS is a criterion-refer-enced, standardized instrument with strongpsychometric characteristics. The AIMS canbe administered by a variety of health careprofessionals who have a background ininfant motor development. Although scoringand interpretation are facilitated by detaileddrawings in the manual and on the scoresheet, use of the test requires extensive knowl-edge in normal and abnormal motor develop-ment. Test administration involves theobservation of 58 items, divided among fourpositions: prone, supine, sitting, and standing.Within each position, three components of

movement are evaluated: weightbearing, pos-ture, and anti-gravity movements. Minimalhandling of the child is required, and parentsare encouraged to be the primary facilitators.Test administration typically requires 20 to 30minutes to complete, but it can take as little as10 to 15 minutes.

The AIMS is a practical tool and is effi-cient when performed by an experienced clini-cian. It yields information of clinical relevanceto occupational therapists and physical thera-pists. The AIMS is unique in that it is one ofthe few tools that emphasize the observationof motor performance. This provides the childthe opportunity to be evaluated in more natu-ral environments, such as the home. It alsoallows the therapist to gather information onthe child’s typical motor performance.

Functional Outcomes Assessment Grid

The Functional Outcomes Assessment Grid(FOAG) (Campbell, 1993) is used by an inter-disciplinary team to develop goals for childrenwith disabilities in direct relation to the func-tional outcomes determined by the team, moni-tor change over time, and determine appropriatelevel of service. It is appropriate for all childrenwith disabilities, regardless of their ages. TheFOAG is based on the American OccupationalTherapy Association’s document, UniformTerminology for Occupational Therapy, 2ndEdition (1994). Individualized observation offunctional skill performance is conducted todetermine which components (physical, envi-ronmental, behavioral, and sensory) are impact-ing positively or negatively on a child’sperformance of a skill. Each component isscored on a 5-point scale, from no problems tosignificant problems that impact on, or prevent,skill performance. Those factors that impactsignificantly on performance of team-estab-lished outcomes are targeted for intervention.The FOAG operationalizes the top-down model

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of measurement as well as the routines-basedmodel. It is highly useful for assessing childrenwith complex needs whose development isknown to be atypical and whose disabilityaffects a broad spectrum of functional skills. Itis most helpful when used as a collaborativeteam decision-making tool, facilitating integrat-ed service provision. The FOAG directly linksassessment to program planning and is individ-ualized to meet the unique needs of the child.

Pediatric Evaluation of DisabilityInventory

The Pediatric Evaluation of DisabilityInventory (PEDI) (Haley, Coster, Ludlow,Haltiwarger, & Andrellas, 1992) determinesfunctional capabilities and performance,monitors progress in functional skill per-formance, and evaluates therapeutic or reha-bilitative program outcomes in children withdisabilities. It can be used with children withand without disabilities who are from 6months to 7.5 years of age. The PEDI is anorm-reference test with strong psychomet-ric characteristics. The test is divided intosubtests focusing on the three functionalskills of self-care, mobility, and social func-tion. Also, environmental modification andamount of caregiver assistance are systemati-cally recorded. Information can be obtainedthrough parent report, structured interview,or professional observation of a child’s func-tional behavior. The PEDI is a reliable andvalid assessment of functional performancein children with significant cognitive andphysical disabilities.

School Function Assessment The School Function Assessment (SFA)

(Coster et al., 1998) is specifically designedto be used within the educational environmentto assess function and to guide program plan-ning for students with disabilities in kinder-garten through grade six. Teachers and other

providers of services in the educational envi-ronment judge a child’s performance onnonacademic tasks divided among those areasassessing level of participation, amount oftask assistance or modification, and level ofperformance in cognitive or physical tasks.The SFA is a criterion-referenced test, and itspecifically links assessment results to thedevelopment of an Individual EducationProgram (IEP). It uses a judgment-based for-mat to gather information on the typical per-formance of a child from the variety ofindividuals involved in the student’s educa-tion. It yields detailed information acrossdomains and environments and, thus, requirescollaboration from those that know thestudent well.

Toddler and Infant Motor Evaluation The Toddler and Infant Motor Evaluation

(TIME) (Miller & Roid, 1994) was developedto measure functional movements in an infantas observed in the infant’s natural environ-ment. The TIME was designed to be used withchildren 4 to 42 months of age with suspectedmotor dysfunction, and to identify those withmild to severe motor problems. It identifiespatterns of movements, evaluates motor devel-opment over time, and assists in interventionplanning and treatment efficacy research. TheTIME is divided into eight subtests: five of thesubtests have been standardized and norm-ref-erenced. The test records the child’s sponta-neous movements in various positions, thechild’s sequence of movements, and anyabnormal movements. The parents interactwith, handle, and position the child accordingto the examiner’s instructions and guidance.The TIME can be used as a comprehensivemotor evaluation or assessment tool. As anevaluation tool, the TIME can be used to iden-tify a child with a motor dysfunction.Repeated measures can be taken with theTIME, thus making it useful for assessing

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motor development over time as well asassessing treatment efficacy and/or motormaturation. The TIME is a valuable clinicaltool. It is a tool that incorporates dynamic sys-tems theory in the assessment of motor func-tions and development. It links a child’sfunction, quality of movement, and motorskills. The TIME is comprehensive anddetailed, providing excellent visual descriptorsof the motor components that are beingassessed. It primarily uses naturalistic obser-vation to gather data, recognizing theimportance of evaluating typical movements asthey are impacted by the child’s environment.

Test of Sensory Functions in Infants The Test of Sensory Functions in Infants

(TSFI) (Degangi & Greenspan, 1988) wasdeveloped to screen and quantify sensory pro-cessing and reactivity in infants. The testincludes five subdomains of sensory process-ing: reactivity to tactile deep-pressure, adaptivemotor responses, visual-tactile integration,ocular-motor control, and reactivity to vestibu-lar stimulation. Infants between 4 and 18months of age can be screened using the TSFI.This criterion-referenced test is most accuratein identifying infants between 10 and 18months of age without sensory processing dis-orders or with sensory dysfunction. This agerange is appropriate because definitive sensoryprocessing dysfunction does not emerge untillate in the first to second years of life.

The TSFI was designed to identify infantswith sensory dysfunction. It can also be usedwith infants who have a known regulatorydisorder or developmental delay. Becauselimited normative data are available, total testscores are used to make screening decisions.The individual subtests, however, can be usedin conjunction with other standardized devel-opmental and neuromotor tests when makingdiagnostic decisions and recommendations(DeGangi & Greenspan, 1988). Abnormal or

at-risk scores on the TSFI indicate that achild has potential problems in sensory pro-cessing and should be referred for furtherevaluation or assessment.

The TSFI is the first test developed toscreen infants for early sensory processingproblems. Although additional data are need-ed in order to use the test as a diagnostic tool,individual subtests and test items can provideuseful clinical information.

LINKING ASSESSMENT FINDINGSTO INTERVENTION PLANNING

Linking assessment findings to a specificintervention plan for a child with a neuromo-tor or sensorimotor dysfunction is a complexprocess. Use of traditional methods to gatherinformation has often resulted in planninginterventions for children with disabilitiesthat are intensive, isolated, and deficit-based.Strategies based on a neuromaturationalframework have dominated therapeutic inter-vention during the last three decades.Contemporary practice, however, is outcomeoriented, with strategies that emphasize func-tional relevance. Planning intervention that isoutcome oriented has four components. Thefirst component is assessment. Throughassessment strategies, the therapist deter-mines what is facilitating or interfering withthe child’s acquisition of a specified out-come. Next, the therapist—in collaborationwith the team—determines whether the focusof intervention should be remediation, pre-vention, promotion, compensation, or alter-ation. Third, the therapist determines themodel of service delivery, which can bedirect, monitoring, or consultation. Finally,the therapist determines the type of strategythat would best meet the child’s needs.Because children with disabilities in sensori-motor or neuromotor skills have complexproblems, a combination of approaches,

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service delivery models, and strategies aremost often used.

The purpose of intervention is fourfold.Therapists use a wide variety of strategies to (1)promote active movement, (2) promote func-tional skills, (3) prevent impairment, and (4) fos-ter the integration of the child into society.

Most of the traditional strategies used bytherapists (see Box 2) require direct, one-to-one application, which often take place insegregated settings such as clinics orassigned rooms in early intervention or edu-cational programs. Although many of thesestrategies are useful in preparing a child formovement by relaxing tight muscles,strengthening weak muscles, or promotingmotor milestone development, when used inisolation they have not been shown toincrease function any more than nonthera-peutic strategies (Warren and Horn, 1996).Additionally, generalization of skills prac-ticed, facilitated, or learned during therapyhas not been demonstrated using the tradi-tional model of service provision.

Frames of Reference

A frame of reference often guides a ther-apist’s selection of strategies used to treatchildren with sensorimotor dysfunction. Thefollowing discussion describes three broadframes of reference that therapists employ:neuromaturational, motor learning, anddynamical systems.

NeuromaturationalThe traditional frame of reference used

by most therapists is neuromaturational.Neuromaturational theory is based on thework of individuals such as Gesell (1945)and Shirley (1931). This theory promotes theconcept that as a child grows and his centralnervous system matures, skills or patterns ofmovement will unfold in a predictable, hier-

archial manner. Treatment strategies based onthis theory attempt to promote skills in chil-dren by following the sequence of skill devel-opment documented in developmental scales.This theory assumes that skills will unfoldnaturally in a normally developing centralnervous system. As the nervous systemmatures, adaptive behaviors and skills willbecome increasingly complex. An emphasisof treatment using this model is the promo-tion of central nervous system maturation.The analysis of reflex integration, facilitationof equilibrium and righting reactions, andpromotion of the components of motor skillsare integral to strategies developed from theneuromaturational model.

Learning-Based Although strategies based on the neuro-

maturational model continue to be the mostcommonly used, the learning-based modelsare often integrated into a holistic treatmentprogram. The learning-based models may bearrayed along a continuum from strict behav-iorism as promoted by Skinner to the morewidely accepted schema theory promoted bySchmidt (1975). Most therapists readilyemploy basic learning theory strategies, suchas providing multimodal feedback, arrangingthe environment to promote skill performance,and repeating actions to increase the likeli-hood that the behavior will be retained. Theschema theory proposes that motor develop-ment emerges from a set of “rules” used by theindividual to evaluate, correct, and updatememory traces for a movement. Generalmotor programs are responsible for organizingthe fundamental components of the move-ment. In order for the general motor programto produce a movement, recall and recognitionschema are used. Recall and recognitionschemas are memories of the relationshipsbetween past movement (recall) and sensory(recognition) patterns and the movement


Box 2. Strategies Used by Physical and Occupational Therapists*

Neurodevelopment Treatment (NDT): Direct handling of children. Specifically designedfor young children with cerebral palsy to facilitate normal patterns of movement.

Myofascial Release (MFR): Specific techniques performed by a therapist to release thebinding down of the fascia. Goal of MFR is to change structure to allow functional change.Promotes structural change techniques followed by functional activities. Little to no scien-tific research to determine effectiveness.

Craniosacral Therapy (CS): Therapist applies gentle pressure through the craniosacral sys-tem to promote movement of cerebral spinal fluid and rhythm. Gentle, noninvasive manipu-lative technique. Used for variety of conditions and promoted for use with infants includingnewborns to diminish effects of birth trauma. Little to no research on effectiveness.

Massage: Variety of specific tactile techniques from gentle laying of the hands to more vig-orous Swedish and Indian techniques. Used for a variety of children, including babies bornprematurely. Research has shown a variety of physiologic benefits including gastrointestinalfunctioning, improved blood and lymphatic circulation, and weight gain in preterm infants.Also shown are improvements in decreasing tactile sensitivity, parent-infant bonding, calm-ing, comforting, and respiration.

Strength Training: Strength training using standard progressive-resistive exercise protocolsmay relate to improvement in function. Sound research on strength in children with cerebralpalsy, but minimal research investigating the effects of strength in children without otherdevelopmental disabilities, such as sensorimotor dysfunction.

Mobilization: Based on concept that immobility affects all systems necessary to producemovement. Is indicated if extra-articular connective tissue abnormally restricts joint motion.Little research done with children to indicate effectiveness.

Sensory Integration (SI): Used with children with mild to moderate sensory processingdysfunction. Treatment uses specific tactile, vestibular, and proprioceptive activities to pro-mote adaptive responses. Goal is to improve the ability of the central nervous system toprocess and integrate sensory inputs.

Conductive Education (CE): Intensive programming using rhythmic intention andsequenced facilitation to enhance organization and production of intentional movementwithin educational and life tasks. Performed by a specially trained and certified conductor.Research from the Peto Institute in Hungary is quite positive.

Movement Opportunities via Education (MOVE): Comprehensive, activity-based cur-riculum for children with severe neuromotor dysfunction. Teaches basic functional motorskills. Process designed to have children acquire skills necessary for sitting, standing, andwalking. Team works on same set of skills so that skills are reinforced and consistent.

*These are only a selection of strategies used by therapists. Therapists also use, for example, assistive tech-nology, splinting, bracing, remediation, and teaching of specific skills.


desired. In schema theory, the development offundamental movement patterns is empha-sized to generate the ability to develop moresophisticated patterns. For example, once themotor pattern for walking is established, indi-viduals expand that pattern to walk on variousterrains and at various speeds. Schema theorycontends that children with disabilities mayhave difficulty initiating a movement, com-pleting the movement with accuracy orprecision, or stopping a movement because ofa lack in recall or recognition schemas.

Children with sensorimotor dysfunctiontypically have problems in accurately produc-ing a movement or controlling the executionof a movement. In schema theory, this wouldbe due to poorly established recognition pat-terns. Schema theory promotes a use of prac-tice that has clear implications for thetreatment of children with sensorimotor dys-function. Specifically, schema theory predictsthat (a) variable practice of a skill or actionpromotes the establishment of a schema, and(b) varied practice works as well as repeatedpractice in promoting accurate performanceof a novel action. Thus, treatment for learningmotor patterns and schemas would be moreeffective if the child practices and repeatsskills in various situations, under changingconditions. The integration of therapeuticstrategies into daily caregiving routines oper-ationalizes this concept. Daily caregiving rou-tines ensure that a skill is practiced within ameaningful context for the child. Performingactivities within the context where they willbe used and are needed increases the likeli-hood that the child will be interested andmotivated in performing the task.

Dynamical SystemsThe dynamical systems theory (Heriza,

1991; Thelan, 1990) is the newest theory toemerge in the physical and occupationaltherapy literature as a way to explain how

development and motor change take place.The dynamical system theory proposes that afunctional movement emerges from the inter-action of a variety of subsystems with theenvironment. In the case of motor skills, thesesubsystems include sensory, neurological,musculoskeletal, emotional, psychological,and other variables. Thus, depending on thetask, any one of these variables can create abarrier to the accomplishment of the task orbe a facilitator of task development. In neuro-maturational theory, the development of skillsis explained as a sequence of skills that buildon one another and emerge in stages. Thedynamical systems perspective, however, pro-poses that a change in behavior occurs as aconsequence of a change in one or more of thevariables that can impact the skill. Also, thedynamical system perspective emphasizesthat change in motor behavior most likely willtake place during times of transition.Treatment based on this perspective focuseson analyzing the variables that are preventingor promoting a specific skill; changing thecombination of inputs, contexts, and tasksthat are important to produce a specific task;and timing treatment to coincide with periodsof transition. Intense therapeutic input duringthese periods of transition is suggested as themost effective treatment strategy to producechanges in motor skill acquisition. Becausethe dynamical system perspective emphasizesthe interaction of multiple systems with theenvironment, the importance of family andcaregiver interactions with the child cannot beoveremphasized.

Approaches to Intervention

As with assessment practices, contempo-rary intervention theory encourages thera-pists to reassess practices and approaches tointervention. Dunn, Brown, and McGuigan(1994) describe five approaches available to

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therapists. These approaches allow therapiststo design intervention strategies that targetthe specific needs of the child and the desiredoutcomes of the family. The approaches alsoprovide a framework for the therapists todetermine the intent of the intervention.Depending on the needs of the child, a thera-pist will most often use a variety of approach-es and expect to change approaches as theneeds of the child change.

Remedial The remedial (or restoration) approach is

the most familiar to therapists and is the basisfor many of the more popular treatment strate-gies. Based on the traditional medical modelof intervention, the remedial approach enablestherapists to identify performance deficits andto seek to resolve them by facilitating age-appropriate sensorimotor capabilities. Thisapproach may be appropriate for some chil-dren; however, using only an approach thatencourages “average” development and “typi-cal” movements may prevent other childrenfrom developing functional skills.

Compensation The compensation approach is often used

with older children, especially those withorthopedic disabilities or significant neuro-motor dysfunction such as spastic type ofquadriplegia. The purpose of the compensa-tion approach is to use assistive technology,adaptive equipment, or other devices to allowa child to perform a skill that the child is notcapable of performing or has yet to master.Compensation strategies also are used to pre-vent further impairment or disability as theyare often used to bypass a barrier to the per-formance of a desired outcome. With youngchildren, compensations are most often usedin combination with other approaches.Compensation strategies also are used to pro-mote development. For example, providing a

child who has minimal or no expressive lan-guage with an alternative communicationsystem (e.g., sign, gestures, or a communica-tion board) will promote the child’s receptivelanguage development by providing him withthe ability to communicate interactively.

Promotion The promotion approach creates natural-

ly occurring activities and routines to pro-mote skill development. This approach istypically used in community-based activityprograms designed for all children, and whichare often based on the DevelopmentallyAppropriate Practice Guidelines (Bredekampand Copple, 1997). The environment andactivities are designed to facilitate develop-mental skill acquisition. This approach iswell suited for children with global develop-mental delays or weaknesses in specific skillperformance areas. Enriched, stimulating child-care programs use the promotion approach andcan easily integrate children with delays intothe program. Other programs such as tum-bling, dance, or library story time utilize apromotion approach.

Prevention The purpose of the prevention approach

is to prevent the development of secondaryimpairments or disabilities in children withknown difficulties. For example, proper posi-tioning of an infant with cerebral palsy isused to help prevent trunk malalignment,which the child has a high risk of developing.Encouraging small-object manipulation orcoloring for toddlers and preschoolers whoshy away from these activities may preventthem from developing visual-motor or hand-writing problems later on.

AlterationThe remedial approach emphasizes the

facilitation of skills not yet acquired by a child.

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The alteration approach, on the other hand,emphasizes the development of skills that aremost functional for a child by providing thechild with an alternative environment in whichto foster skill development and use. The alter-ation approach requires that the therapist andteam weigh the importance of changing achild’s aberrant behavior or the lack of skillagainst any given activity or environment. Forexample, Andrew is a child with sensory-pro-cessing deficits who becomes behaviorally dis-ruptive when in a highly sensory-chargedenvironment. His intervention team, however,has identified his poor language skills as themost immediate concern. Since Andrew’sbehavior can interfere with his ability to bene-fit from the language enrichment offered tohim, his team has several options. The teammembers can decide to teach Andrew behav-iors that are age appropriate (remedialapproach) within the sensory-charged environ-ment; they can change the environment bydecreasing sensory stimulation (compensationapproach); or they may decide to move Andrewto a minimal-sensory environment (alterationapproach). Although the first two options maybe appropriate and necessary, it may be morefunctional to find a better environmental matchfor Andrew so that his intervention can focuson his language development, which is theidentified area of concern.

Models of Service Provision

In addition to identifying the variousapproaches to intervention needed by a child,therapists also must decide on the most effec-tive and efficient service delivery model. Asnoted above, the traditional interventionmodel—the remedial approach—promotesdirect one-to-one therapeutic interventions.Contemporary practice, however, promotes theuse of three models of service provision: direct,monitoring, and consultation (Dunn &

Campbell, 1991). These models allow the ther-apist to design a comprehensive interventionplan that takes into account the outcomesdeveloped by the team, the individual strengthsand needs of the child, family priorities, theenvironment, and other support factors.

Direct Therapists most often use a direct service

model of intervention. In this model, thera-pists provide one-to-one therapy, usually in asegregated setting (e.g., a clinic, a speciallydesigned room within a childcare or educa-tional program, or in a separate space withina classroom). Usually, the purpose of directservice is to provide intensive, remedial inter-vention to a child. Therapists use direct ther-apy to provide specialized therapeuticintervention strategies. Strategies are used toteach specific skills, introduce new behaviorsto the child, change maladaptive behaviors,or to increase a child’s tolerance to sensori-motor experiences.

Recent changes in research, legislativemandates, and societal attitudes about chil-dren with disabilities are creating a shift awayfrom the provision of direct service to allchildren to an integrated service delivery pro-gram. Integrated programming is defined as:• Specialized instruction• Individualized to meet the unique

strengths and needs of a child, within anaturally occurring environment

• With other children without disabilities • Within the context that the skill is

required (McWilliam, 1996)

Research comparing the benefits of inte-grated and direct service delivery has indicat-ed little difference in the enhancement ofskills in individual children (McWilliam,1996). However, other benefits have beenrelated to integrated therapy models. (SeeAdvantages to Integrated Therapy, Box 3.)

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Although changes in standardized testingscores were the same following interventionsbased on integrated or direct service deliverymodels, Cole, Harris, Eland, and Mills (1989)found that teachers preferred the integratedmodel. In teaching a child with severe motoricinvolvement how to use a microswitch,Giangreco (1986) found performance improvedmore during integrated programming thanwhen teaching was conducted in isolation.

Obviously, more research needs to bedone in this area, especially with childrenwith various needs and conditions. It is clear,however, that the field is moving rapidly todevelop programs that provide integratedtherapy. In order to provide effective treat-ment within an integrated model, therapistsrequire skills in putting into operation twoadditional service delivery models: monitor-ing and consultation.

MonitoringMonitoring is a method to ensure that ther-

apeutic strategies become infused into natural-ly occurring activities and are carried outthroughout the day. Therapists monitor pro-gramming when they create and supervise thedelivery of a plan that is carried out by some-one else (Dunn, 1996). Monitoring can be usedalone or in combination with direct service andconsultation. Monitoring service provisionmay be as time consuming as direct service,especially initially. Therapists are required toensure that any program or activity taught toanother person is being carried out appropri-ately. Thus, monitoring requires therapists to • Design the activities• Teach the provider specific methods of

integrating therapeutic strategies intoexisting routines

• Observe the provider performing theactivities

• Adapt and update the activity asnecessary

• Supervise the implementation, and beresponsible for documenting the child’sperformance

Monitoring is beneficial because (a) itincreases the amount of time a child is bene-fiting from a therapeutic strategy, (b) the strat-egy will promote generalization because it isbeing conducted within a naturally occurringactivity, and (c) it provides continuous, ongo-ing reinforcement of the desired behavior.

ConsultationMonitoring service delivery requires that

the therapist design the activities and therapeu-tic strategies that will be used by others to pro-mote needed therapeutic skills. In consultation,

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Box 3. Advantages toIntegrated Therapy

• Active participation is enhancedbecause service to children is providedin a familiar, comfortable, nonthreaten-ing setting.

• Developmentally appropriate, naturallyoccurring settings are enriching andtherapeutic.

• Natural environments provide routinecues and opportunities to provide thera-peutic tasks within context.

• Functional behavior is supportedbecause the child’s actions reinforcedwithin the natural context and by peers.

• Generalization of skills is enhancedbecause learning is taking place withinthe environment in which the skills areexpected.

• Normalization is valued and enhanced.All children recognize that each childhas strengths and needs and that special-ized services can be beneficial to all.


the consulting therapist assists another therapistin meeting jointly identified goals. The consult-ing therapist contributes her expertise to helpsolve a problem or dilemma for anotherprovider of service to a child. Hanft and Place(1996) promote the use of collaborative consul-tation as the preferred method of consultation.Collaborative consultation is an interactiveprocess in which various team members worktogether to generate creative solutions to aproblem. As the field moves toward integrat-ed, discipline-free program plans, collabora-tive consultation will help teams put intoeffect the plan for the child, within the struc-ture of an inclusive setting. Collaborativeconsultation is also used within the tradition-al model of direct service delivery. Effectiveconsultation has three critical elements:dynamic interaction among the team mem-bers, respect, and a belief that the consulta-tion will help achieve a common goal.Consultative service provision accepts thatchildren with disabilities present with com-plex problems and issues that can only behelped by creative use of the expertise pro-vided by all team members. Collaborativeconsultants must free themselves from disci-pline-bound perspectives and be open tocombining various systems and approachesto assist the child and family. Ideally, thesolution to a specific challenge reflects avariety of approaches. Table 3 illustrates theuse of the five service provision approachesand three models of service.

EFFECTIVENESS OF SPECIFICMOTOR INTERVENTION

The effectiveness of therapeutic input forchildren with neuromotor and sensorimotordisorders has been of particular interest forthe last 30 years. Generally, research thatassessed specific developmental skillimprovement has shown that therapeutic

intervention had little effect on motor devel-opment. However, research has documentedother nonmotor benefits for children receiv-ing specific therapeutic intervention andwhen studies use a single-subject design. Oneof the earliest studies assessing the benefitsof physical therapy for children with cerebralpalsy (Wright & Nicholson, 1973) indicatedthat, although neuromotor performance wasnot necessarily enhanced by intervention,nonmotor benefits such as family competen-cy, child happiness, sociability, and confi-dence were seen. Thus, there has been arecent emphasis on examining broader issuesin development and functional capacity inchildren with known disabilities. Additionally,early research into the benefits of therapy forchildren with motor disabilities has indicatedthat therapy only minimally affected impair-ments in children with significant motor dys-function (Shonkoff & Hauser-Cram, 1987).Based on this limited research base, physicaland occupational therapists are encouraged toexamine disability or the inability to performa functional activity rather than to examineindividual impairments.

Types of Intervention

For purposes of this section, the term“intervention” is limited to specific approach-es used by therapists that purport to influencethe neuromotor and sensorimotor processesto improve function, reach targeted out-comes, or promote developmental skillacquisition. Functional outcomes includeperformance on tasks related to developmen-tally appropriate tasks, interaction within theenvironment, and purposeful activity.Functional outcomes deemphasize changemeasured on standardized, norm-referencedtests of developmental skills. Functional out-comes include nonmotor benefits, such asdecreased need for assistance by caregivers,

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ICD

L Clinical P

ractice Guid

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Table 3. Examples of Service Provision Approaches and Models

Service Provision Approaches

Remediate

Facilitate neckextensor musclesso child can lookat friends whenplaying

Supervise theteacher’s aide tofacilitate tone forreaching during agame

Teach classroomstaff how to incor-porate enhancedsensory input intoplay routines dur-ing free time

Compensate

Fabricate a splintto enable the childto hold the cup atsnack time

Supervise afeeding programthat minimizes thetime for eating andenables socializa-tion

Provide the teamwith informationfrom skilledobservations thatenables them toselect the best playpartner for a child

Alter

Select acommunitypreschool based onthe level of noisethe child can manage

Work with parentsto identify whichcommunitylocations will bebest for theirfamily outings

Work with parentsto identify whichcommunitylocations will bebest for theirfamily outings

Prevent

Facilitate weightbearing duringinfancy to preventpossible delays inwalking

Create a “positionsalternatives" chartfor the aides toprevent skinbreakdowns

Teach a parent arange-of-motionsequence topreventdeformities

Promote

Provide a playprogram for thecommunity for allchildren to attend

Oversee thedevelopment of amorning preschoolroutine thatoptimizes earlydevelopmentpossibilities

Assist the childcare provider todevelop acomprehensivecurriculum

Direct

Monitoring

Consultation

Serviceprovisionmodels

Adapted with permission from Dunn, W. (1996). Occupational Therapy. In R. A. McWilliam (Ed.), Rethinking pull-out services in early intervention: A professional resource (pp. 267-313). Baltimore: Paul H. Brookes.


caregivers’ sense of competence and confi-dence in caring for the child, and other relat-ed improvements.

Although many types of interventionwere listed previously in Box 2, the mostcommon form of intervention used with chil-dren with primary neuromotor deficits suchas cerebral palsy is a neurofacilitation type.The most common intervention of this type isneurodevelopmental treatment (NDT). Inter-vention for children with primary sensorimo-tor deficits, such as those on the autisticspectrum, is considered sensorimotor inter-vention, the most common being sensoryintegration. Contemporary practice promotesa more task-oriented approach based on thesystems or motor-learning perspective. Thisapproach is less diagnosis (or deficit)dependent, and is consistent with the empha-sis on functional outcomes rather than onfacilitation of developmental milestones.

The following discussion reviewsresearch published in the 1990s and which isrelated to intervention in the neurodevelop-mental, sensorimotor, and task-orientedapproaches. Readers interested in prior stud-ies are referred to 1980s reviews of meta-analysis (Ottenbacher, Biocca, DeCremer,Gevelinger, Jedovic, & Johnson, 1986;Ottenbacher & Peterson, 1985; Shonkoff &Hauser-Cram, 1987) and qualitative reviews(Harris, 1987, 1988).

Neurodevelopmental Treatment Recent randomized, controlled trials

(Law et al., 1991; Palmer, 1990) examiningthe benefits of NDT produced results that areconsistent with previous studies. Studies thatutilized a group experimental design foundlittle definitive support that NDT is any morebeneficial than other types of intervention(such as general stimulation) in enhancingthe attainment of developmental skills(Palisano, 1991). However, families whose

children received this type of interventionwere found to be more emotional and verbal-ly responsive to their children and more con-fident in caregiving (Palmer et al., 1990). Inthis era of family-centered care and recogni-tion of the importance of parent-child inter-actions, these findings support intervention.These findings are especially important forchildren with disabilities such as cerebralpalsy. Studies utilizing a single-subjectdesign, however, are more supportive of NDTin improving specific motor skills in childrenwith cerebral palsy. Unlike traditional groupdesigns, the single-subject design is con-cerned with individual performance on spe-cific tasks, unique to the individual beingtreated. Embrey, Yates, and Mott (1990)found that improvement in specific compo-nents of gait could be seen in children receiv-ing intensive intervention. Generalization ofthis single-subject design is limited, but thedesign shows promise as a strategy to indi-cate improvement in children whose disabili-ties make it difficult to identify them as ahomogenous group.

The difficulty in establishing the efficacyof NDT is multifaceted. One primary prob-lem is that NDT is an approach to treatment,rather than a series of activities. Thisapproach, based on neurophysiological prin-ciples, is individualized to meet the needs ofa specific child and is modified based on theresponse of that child. Thus, an assessment ofthe techniques is very difficult. Unlike med-ication or a specific surgical procedure, spe-cific treatment techniques vary fromtherapist to therapist, further complicatingthe analysis of the approach. As noted, moststudies examining the effectiveness of theNDT approach have used developmental skillacquisition tests or checklists to determineoutcome. These tools may not be responsiveto the changes produced by using NDT.Alternative measurement instruments, such

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as the Gross Motor Function Measure(Russell et al., 1993), the TIME (Miller &Roid, 1994), or the use of goal attainmentscaling (Ottenbacher & Cusick, 1989), mayprove more helpful in determining if NDTcan produce change over time in childrenwith complex neuromotor dysfunction.

Learning-Based ModelsAlthough there is only limited research on

the learning-based (or task-oriented)approach used with children, available evi-dence indicates that this approach may bemore useful in changing functional skills inchildren with significant motor disabilities.Horn, Warren, and Jones (1995) showed thatdeveloping activities targeting specific behav-iors was successful in supporting the attain-ment of those functional behaviors. There alsoseemed to be a generalization effect in thatmovements not targeted, but assessed,improved. The benefits of this approach maybe due to the principles of motor learning onwhich it is grounded (Larin, 1994). Motorlearning indicates that motor performance isenhanced when children are afforded oppor-tunities to experience and actively practicespecific activities or tasks. The theoreticalbasis of the motor learning approaches pro-vides evidence that should encourage thera-pists to examine the effects of integratingthese principles into the development ofmotor skills, performance, and function.

Sensory Integration Children with mild to moderate problems

having a sensorimotor basis, such as dysprax-ia or sensory-processing disorder, oftenreceive sensory integration (SI). According toAyres (1979), the theory of SI can be used toexplain the relationship between sensory pro-cessing and behavior. For example, impairedsensory processing in children with autismhas been linked to dysfunction in relating,

arousal, interactions with others, and goal-directed play (Greenspan & Weider, 1997;Koomar & Bundy, 1991). It is these relation-ships that provide support for the use of SIwith children with autism, as well as othersignificant disabilities. According to the theo-retical constructs, children who receivesensory integration should improve in thefollowing areas ( Parham and Malloux, 1996):• Adaptive responses • Self-confidence and self-esteem • Motor skills • Daily living skills and personal-social

skills • Cognition, language, and academic per-

formance

As with NDT, there is little empirical evi-dence of the effectiveness of SI or other strate-gies with a sensory component commonlyused by therapists for children with a variety ofconditions (Ottenbacher, 1991; Vargas &Camilli, 1999). Also similar to NDT, the litera-ture regarding SI demonstrates the many chal-lenges faced in reaching any consensus as to itseffectiveness. Children across studies vary, out-come measures do not focus on the same infor-mation, and there is little control of the exacttreatment techniques employed. Anotherunique limitation is that SI is a complex con-struct that theoretically is presented as a whole.In reductionist-type research, the SI constructmust be broken down into individual compo-nent pieces. Consequently, research is evaluat-ing the effectiveness of each component ofsensory stimulation rather than the overall con-struct of SI (Ottenbacher, 1991). Additionally,most of the research on SI has studied childrenwith learning disabilities although many morechildren have sensory-processing disorders,which may be amenable to the effects of SI.

However, even with these limitations, sup-port exists for activities that are consideredsensory integrative. Humphries, Wright,

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Snider, and McDougall (1992) found thatchildren with learning disabilities whoreceived SI showed improved motor planning.Using a single-subject, multiple-baselinedesign, Case-Smith and Bryan (1999) showedthat preschoolers with autism improved onspecific, individualized activities to gainmastery in play and engagement. As withNDT, there appears to be accepted, theoreticalsupport for treatment based on sensory inte-grative principles, with minimal empiricalevidence. Because the SI treatment approachis so widely used by occupational therapists(Watling, Dietz, Kanny, & Mclaughlin, 1999;Case-Smith & Miller, 1999) it is of utmostimportance that research be conducted toassess its attributes, effectiveness, and overallbenefits to children with complex sensorimo-tor considerations and their families.

IMPLICATIONS

Children with developmental disabilitiesoften have significant problems related tomotor performance, even when their primarydiagnosis is not motor-based. Motor planning,sensory processing, and motor delays are allseen in children on the autism spectrum orwith mental retardation, learning disabilities,language processing difficulties, or othersimilar diagnoses. This is especially true inyoung infants because the lack of attainmentin motor milestones is often the area initiallyseen as problematic. Consequently, physicaland occupational therapists become the pro-fessionals who frequently provide the initialintervention. As early interventionists, they arein an ideal position to effect functional changeby applying strategies based on sound theoret-ical principles in a functional manner.

Research on the effectiveness of interven-tion with children with significant sensori-motor disabilities is more successful whenfunctional skills are targeted. According to

Wolery (1996), functional skills includethose behaviors that are:1. Useful2. Enable the child to be more independent3. Foster learning more complex skills4. Allow a child to live in a less restrictive

environment5. Enable the child to be cared for more

easily

Infusing NDT, SI, and the learning-basedsystem approach into daily caregiving rou-tines and embedding strategies into naturalenvironments increase the likelihood thatchildren will obtain and retain functionalbehaviors. Although limited, there are someinitial research findings that lend support tothis service delivery model. McWilliam,Tocci, and Harbin (1995) found that whenparents of children who were receivingdirect, individualized, clinic-based therapywere asked what they valued most from thesessions, the parents said it was the informa-tion they received from the therapists. Thesesame parents, however, were not comfortablein discussing what they felt their child coulddo at home as a result of the therapy. Thesefindings indicate that families value theinformation therapists provide and use thisinformation in caring for their children. Theyare unsure, however, what functional changeis directly linked to a specific intervention.

Clearly, research is needed to determinethe effectiveness of these treatment strategies.Research should include a variety of strate-gies that focus on a variety of areas. Althoughwidely accepted as appropriate theoreticalconstructs, the basis of the theoretical per-spectives of various intervention approachesshould be examined to validate their useful-ness in explaining sensorimotor and/or neuro-motor dysfunction. This recommendation isespecially relevant for the theoretical bases ofNDT and SI. Both of these approaches and

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their treatment techniques were developedfrom a neuromaturational view of develop-ment. Assessing their validity in light of thecontemporary motor-learning and controltheories, as well as in light of the systemsperspective, may be helpful in establishingsound research hypotheses.

Clinical research examining the effective-ness of specific techniques must clearlydescribe the techniques and the interventionprocedure. Because of the variation in treat-ment, concluding that an approach is effectiveor ineffective is misleading. Specific techniquesmay be more advantageous than others for cer-tain populations of children. Additionally, theoutcomes sought through treatment must beclearly defined in functional, measurable terms.Improvements in processing ability or posturalcontrol are goals that have little direct meaningto the child’s daily caregiving. To be functional,outcomes should have a direct relationship toWolery’s five areas.

Finally, measurement tools need to beresponsive to the changes seen during thera-peutic intervention. Too often, standardizeddevelopmental tools have been used to deter-mine change over time in children withknown disabilities. As these tools were notdeveloped to detect these kinds of changes,their value is limited. Use of functional toolssuch as the FOAG, the PEDI, or the SFA (aspreviously described) may prove more benefi-cial. Intervention outcome is linked directly totasks on these systems; thus, relevance to thetreatment strategies may be clearly identified.

SUMMARY

Significant changes in therapeutic inter-ventions provided to children with sensorimo-tor dysfunction have occurred during the past20 years. These changes have primarilyoccurred in methods of gathering informationabout a child’s functional status and delivering

appropriate, functionally oriented services.Therapists are revising traditional servicedelivery models to reflect the growing empha-sis on providing integrated therapeutic ser-vices within inclusive settings. The physicaland occupational therapists’ expertise in neuro-motor development, the effects of sensorimotorskills on function and other developmentalareas, and the therapists’ ability to task analyzeall contribute to contemporary service delivery.In recognition of the overlap among serviceproviders, integrated, discipline-free program-ming is becoming more common.

This chapter outlined models of informa-tion-gathering that therapists use to evaluateand assess infants and young children. It alsoreviewed several recently published measure-ment tools used by pediatric physical and occu-pational therapists. Instruments are used as onecomponent of the measurement process to (a)screen children for potential developmentalconcerns, (b) evaluate children to determinediagnosis or eligibility for services, or (c)assess children to plan therapeutic interventionor to determine the effects of intervention.

Therapists should be aware of the purposeof each tool and the information they wouldlike to gain from the tool prior to selecting aninstrument. Therapists may need to use a vari-ety of tools and strategies to meet their screen-ing, evaluation, or assessment objectives.

In addition to the measurement instrumentused to gather information, a comprehensivemeasurement strategy should encompass theprinciples developed by ZERO TO THREE,National Center for Infant, Toddlers, andFamilies (Greenspan & Meisels, ZERO TOTHREE Work Groups on DevelopmentalAssessment, 1996) (see Chart 1).

These principles recognize that thedevelopment of infants and young childrenis complex and requires an appreciation ofthe child’s abilities within a functional con-text. The therapist needs to appreciate that

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the assessment or evaluation of neuromotordevelopment can be influenced by theinteraction of the child with significant others,the environment, and the infant’s own neurobe-havioral state. This is especially critical whenestablishing intervention priorities, outcomes,goals, and strategies. Collaboration with otherprofessionals, family members, and caregiversof the child will increase the likelihood that thetherapist’s findings will reflect the child’s capa-bilities across environments and her currentcapacities and strengths, as well as identify bar-riers to optimal development. Individualizedassessment of a child’s neuromotor skills shouldcapture the child’s movement patterns, compo-nents of movement, and the use of movementwithin a functional activity, as well as the

child’s sensory processing and developmentalskills acquisition.

The chapter also discussed treatment ofchildren with sensorimotor dysfunction. Anemphasis was placed on service deliveryapproaches and models reflecting the evolv-ing context of service delivery for all chil-dren. These models and approaches allow thetherapist to develop a variety of treatmentstrategies that best meet a child’s needs andreflect evolving frameworks on sensorimotordevelopment and behavioral change. ■

AcknowledgmentsThe authors would like to thank Elaine Anderson,

M.P.H., P.T., for her assistance in the preparation ofthis manuscript.

Chart 1. Principles of Assessment

1. Assessment must be based on an integrated developmental model.2. Assessment involves multiple sources of information and multiple components.3. An assessment should follow a sequence.4. The child’s relationship and interactions with his or her most trusted caregiver should

form the cornerstone of an assessment.5. An understanding of the sequence and timetables in typical development is essential as a

framework for the interpretation of developmental differences among infants and tod-dlers.

6. Assessment should emphasize attention to the child’s level and pattern of ongoing expe-rience and to functional capacities, which represent an integration of emotional and cog-nitive abilities.

7. The assessment process should identify the child’s current competencies and strengths aswell as the competencies that will constitute developmental progression in a continuousgrowth model of development.

8. Assessment is a collaborative process.9. The process of assessment should always be viewed as the first step in a potential inter-

vention process.10. Reassessment of a child’s developmental status should occur in the context of day-to-day

family and/or early intervention activities.

From Greenspan & Meisels with the ZERO TO THREE Work Groups on DevelopmentalAssessment (1996). In S. J. Meisels & E. Fenichel (Eds.) New visions for the developmentalassessment of infants and young children. Washington, D.C.: ZERO TO THREE, NationalCenter for Infants, Toddlers, and Families.


Alyward, G. (1993). Bayley infantneurodevelopmental screener. San Antonio,TX: Psychological Corporation.

American Occupational Therapy Asso-ciation. (1994). Uniform technology foroccupational therapy: Application to prac-tice. Rockville, MD: American Occupa-tional Therapy Association.

Ayres, J. (1979). Sensory integration and thechild. Los Angeles: Western PsychologicalServices.

Bayley, N. (1993). Bayley scales of infant devel-opment-II. San Antonio, TX: PsychologicalCorporation.

Berenthal, B., Campos, J., & Barrett, K.(1984). Self-produced locomotion: Anorganizer of emotional, cognitive, andsocial development. In R. Ende and R.Herman (Eds.), Continuities and disconti-nuities in development (pp. 175-209). NewYork: Plenum.

Bredekamp, S., & Copple, C. (Eds.) (1997).Developmentally appropriate practice inearly childhood programs, revised edition.Washington, D.C.: National Association forthe Education of Young Children.

Bricker, D. (1993). Assessment, evaluationand programming systems for infants andchildren. Baltimore: Paul H. Brookes.

Bricker, D., Squires, J., & Mounts, L. (1995).Ages and stages questionnaires. Baltimore:Paul H. Brookes.

Campbell, P. H. (1993). Administrationguide: Functional outcome assessmentgrid. Philadelphia: Temple UniversityCenter for Research in HumanDevelopment and Education.

Case-Smith, J. (1996). Analysis of currentmotor development theory and recentlypublished infant motor assessments. Infantsand Young Children, 9, 29-41.

Case-Smith, J., & Bryan, T. (1999). Theeffects of occupational therapy with senso-ry integration emphasis on preschool-agechildren with autism. American Journal ofOccupational Therapy, 53, 489-497.

Case-Smith, J., & Miller, H. (1999).Occupational therapy with children withpervasive developmental disorders.American Journal of OccupationalTherapy, 53, 506-513.

Chandler, L. S., Swanson, M.W., & Andrews,M. S. (1980). Movement assessment ofinfants. Rolling Bay, WI: Infant MovementResearch.

Cicchetti, D., & Wagner, S. (1990). Alternativeassessment strategies for the evaluation ofinfants and toddlers: An organizational per-spective. In S. J. Meisels & J. P. Shonkoff(Eds.), Handbook of early childhood inter-vention. New York: Cambridge UniversityPress.

Cintas, H. L. (1995). Cross-cultural similari-ties and differences in development and theimpact on parental expectations on motorbehavior. Pediatric Physical Therapy, 7,103-111.

Cole, K., Harris, S., Eland, S., & Mills, P.(1989). Comparison of two service deliverymodels: In-class and out-of-class therapyapproaches. Pediatric Physical Therapy, 1,49-54.

Coster, W., Deeney, T., Haltiwanger, J., &Haley, S. (1998). School function assess-ment. San Antonio, TX: Therapy SkillBuilders.

DeGangi, G., & Greenspan, S. I. (1988). Thedevelopment of sensory functions ininfants. Physical and OccupationalTherapy in Pediatrics, 8, 21-33.

DeGangi, G., & Greenspan, S. (1989). Test ofsensory functions in infants. Los Angeles:Western Psychological Services.

REFERENCES


Dunn, W. (1996). Occupational therapy. InR.A. McWilliam (Ed.), Rethinking pull-outservices in early intervention, (pp. 267-313). Baltimore: Paul H. Brookes.

Dunn, W., Brown, T., & McGuigan, A.(1994). The ecology of human perform-ance: A framework for considering theeffect of context. American Journal ofOccupational Therapy, 48(7), 595-607.

Dunn, W. & Campbell, P. H. (1991).Designing pediatric service provision. InW. Dunn (Ed.), Pediatric occupationaltherapy (pp. 130-159). Thorofare, NJ:Slack.

Embrey, D. G., Yates, L., & Mott, D. H.(1990). Effects of neurodevelopmentaltreatment and orthoses on knee flexion dur-ing gait: A single-subject design. PhysicalTherapy, 70, 626-637.

Foley, G.M. (1990). Portrait of the arena eval-uation: Assessment in the transdisciplinaryapproach. In F. D. Gibbs and D. M. Titi(Eds.), Interdisciplinary assessment ofinfants: A guide for early intervention pro-fessionals. Baltimore: Paul H. Brookes.

Folio, M. & Fewell, R. (1983). Peabodydevelopmental motor scale. Allen, TX:DLM Teaching Resources.

Gentile, A. M. (1987). Skill acquisition:Action, movement, and neuromotor process-es. In J. H. Carr, & R. B. Shepard (Eds.),Movement science: Foundations for physicaltherapy in rehabilitation. Rockville, MD:Aspen Systems.

Gesell, A. (1945). The embryology of behav-ior: The beginnings of the human mind.Philadelphia: J. B. Lippincott.

Giangreco, M. F. (1986). Effects of integrat-ed therapy: A pilot study. Journal of theAssociation for Persons with SevereDisabilities, 11(3), 205-208.

Greenspan, S. I., & Meisels, S. (1993).Toward a new vision for the developmentalassessment of infants and young children.

Arlington, VA: ZERO TO THREE,National Center for Clinical InfantPrograms.

Greenspan, S. I., & Meisels, S. J., with the Zero-to-Three Work Group on DevelopmentalAssessment (1996). In S. J. Meisels and E.Fenichel (Eds.), New visions for the develop-mental assessment of infants and young chil-dren. Washington, D.C.: ZERO TO THREE,National Center for Infants, Toddlers, andFamilies.

Greenspan, S. I., & Weider, S. (1997). Anintegrated developmental approach to inter-ventions for young children with severe dif-ficulties in relating and communicating.Zero to Three, 17(5), 5-8.

Haley, S., Coster, W. J., Ludlow, I. H.,Haltiwanger, J. T., & Andrellas, P. (1992).Pediatric evaluation of disability inventory.Boston: PEDI Research Group, Departmentof Rehabilitation Medicine, New EnglandMedical Center Hospital.

Hanft, B., & Place, P. (1996). The consultingtherapist: A guide for OTs and PTs in theschool. San Antonio, TX: Therapy SkillBuilders.

Harris, S. (1988). Early intervention: Doesdevelopmental therapy make a difference?Topics in Early Childhood SpecialEducation, 7, 20-32.

Harris, S. (1987). Early intervention for chil-dren with motor handicaps. In M. J.Guralnick & F. C. Bennett (Eds.), The effec-tiveness of early intervention for at-risk andhandicapped children (pp. 175-212).Orlando, FL: Academic Press.

Heriza, C. (1991). Motor development:Traditional and contemporary theories. InM. J. Lester (Ed.), Contemporary manage-ment of motor control problems:Proceedings of the II Step Conference.Alexandria, VA: Foundation for PhysicalTherapy.

209


Horn, E. M., Warren, S. F., & Jones, H. A.(1995). An experimental analysis of aneurobehavioral intervention. Develop-mental Medicine and Child Neurology, 37,697-714.

Humphries, T., Wright, M., Snider, L., &McDougall, B. (1992). A comparison of theeffectiveness of sensory integrative therapyand perceptual-motor training in treatingchildren with learning disabilities.Developmental and Behavioral Pediatrics,13(1), 31-40.

Johnson-Martin, N. M., Jens, K. A., Attermeier,S. M., & Hacker, B. J. (1991). The Carolinacurriculum for infants and toddlers with spe-cial needs. (2nd ed.) Baltimore: Paul H.Brookes.

Kirshner, B., & Guyatt, G. (1985). A method-ological framework for assessing healthindices. Journal of Chronic Diseases, 38,27-36.

Koomar, J., & Bundy, A. (1991). The art andscience of creating direct intervention fromtheory. In A. G. Fisher, E. A. Murray, & A.C. Bundy (Eds.), Sensory integration:Theory and practice (pp. 251-317).Philadelphia: F. A. Davis.

Larin, H. (1994). Motor learning: Theoriesand strategies for the practitioner. In S.Campbell (Ed.), Physical therapy for chil-dren (pp. 157-182). Philadelphia: W. B.Saunders.

Law, M., Cadman, D., Rosenbaum, P.,Walters, S., Russell, D., & DeMateo, C.(1991). Neurodevelopmental therapy andupper extremity casting for children withcerebral palsy. Developmental Medicineand Child Neurology, 33, 379-387.

Lyons, B. G. (1984). Defining a child’s zone ofproximal development: Evaluation processfor treatment planning. American Journal ofOccupational Therapy, 38, 446-451.

McGraw, M. B. (1945). The neuromuscularmaturation of the human infant. New York:Hafner Press.

McWilliam, R. (1996). How to provide inte-grated therapy. In R. A. McWilliam (Ed.),Rethinking pull-out services in early inter-vention (pp. 147-184). Baltimore: Paul H.Brookes.

McWilliam, R. A. (1992). Family centeredintervention planning: A routines basedapproach. San Antonio, TX: Therapy SkillBuilders.

McWilliam, R. A., Tocci, L., & Harbin, G. L.(1995). Services are child-oriented andfamilies want them that way. Chapel Hill:Early Childhood Research Institute onService Utilization, Frank Porter GrahamChild Development Center, University ofNorth Carolina.

Miller, L. J., & Roid, G. H. (1994). TheTIME: Toddler and infant motor evalua-tion. Tucson, AZ: Therapy Skill Builders.

Newborg, J., Stock, J. R., & Wnek, L. (1984).Battelle developmental inventory. Allen,TX: DLM Teaching Resources.

Ottenbacher, K. (1991). Research in sensoryintegration: Empirical perceptions andprogress. In A. G. Fisher, E. A. Murray, &A. C. Bundy (Eds.), Sensory integration:Theory & practice (pp. 385-399).Philadelphia: F. A. Davis.

Ottenbacher, K., Biocca, Z., DeCremer, G.,Gevelinger, M., Jedovic, K. B., & Johnson,M. B. (1986). Quantitative analysis of theeffectiveness of pediatric therapy:Emphasis on neurodevelopmental treat-ment approach. Physical Therapy, 66,1095-1101.

Ottenbacher, K., & Cusick, A. (1989). Goalattainment scaling as a method of clinicalservice evaluation. American Journal ofOccupational Therapy, 44, 519-525.

Ottenbacher, K., & Peterson, P. (1985). Theefficacy of early intervention programs for

210


children with organic impairment: A quan-titative review. Evaluation and ProgramPlanning, 8, 135-146.

Palisano, R. (1991). Research on the effec-tiveness of neurodevelopmental treatment.Pediatrics Physical Therapy, 3, 143-148.

Palmer, F. B., Shapiro, B. S., Wachtel, R. C.,Allen, M. C., Hiller, J. E., Harryman, S. F.,Mosher, B. S., Meinert, C. L., & Capute, A.J. (1990). Infant stimulation curriculum forinfants with cerebral palsy: Effects oninfant temperament, parent-infant interac-tion, and home environment. Pediatrics, 85(Suppl.), 411-415.

Parham, L. D., & Malloux, Z. (1996).Sensory integration. In J. Case-Smith, A. S.Allen, & P. N. Pratt (Eds.), OccupationalTherapy for Children (3rd ed.) (pp. 307-356). St. Louis, MO: Mosby.

Piper, M. (1993). Theoretical foundations forphysical therapy assessment in early infan-cy. In I. J. Wilhelm (Ed.), Physical therapyassessment in early infancy. New York:Churchill Livingstone.

Piper, M., & Darrah, J. (1993). Motor assess-ment of the developing infant. Philadelphia:W. B. Saunders.

Russell, D., Rosenbaum, P., Garland, C.,Hardy, S., Lane, M., Plews, M., McGavin,H., Cadman, D., & Jarvis, S. (1993). Grossmotor function measure. Hamilton, Ontario:Children’s Developmental RehabilitationProgram at Chedoke-McMaster Hospitals.

Schmidt, R. A. (1975). A schema theory ofdiscrete motor skill learning. PsychologicalReview, 82, 225-260.

Shelton, T. (1989). The assessment of cogni-tion/intelligence in infancy. Infants andYoung Children: An InterdisciplinaryJournal of Special Care Practice, 1, 10-25.

Shirley, M. M. (1931). The first two years: Astudy of twenty-five babies. Vol. 1: Postural

and locomotor development. Minneapolis,MN: University of Minnesota Press.

Shonkoff, J. P., & Hauser-Cram, P. (1987).Early intervention for disabled infants andtheir families. Pediatrics, 80, 650-658.

Taylor, R. L. (1993). Instruments for thescreening, evaluation, and assessment ofinfants and toddlers. In D. M. Bryant & M.A. Graham (Eds.), Implementing early inter-vention: From research to effective practice.New York: Guilford.

Thelan, E. (1990). Coupling perception andaction in the development of skill: A dynam-ic approach. In H. Block and B.T. Berenthal(Eds.), Sensorimotor organization anddevelopment in infancy and early childhood(pp. 39-56). Dordrecht, Netherlands: KluwerAcademic.

Vargas, S., & Camilli, G. (1999). A meta-analy-sis of research on sensory integration treat-ment. American Journal of OccupationalTherapy, 53, 189-198.

Warren, S. F., & Horn, E. (1996) Generalizationissues in providing integrated services. In R.A. McWilliam (Ed.), Rethinking pull outservices in early intervention: A professionalresource (pp. 121-143). Baltimore: Paul H.Brookes.

Watling, R., Dietz, J., Kanny, E. M., &Mclaughlin, J. F. (1999). Current practiceof occupational therapy for children withautism. American Journal of OccupationalTherapy, 53, 498-505.

Wolery, M. (1996). Early childhood specialand general education. In R. A. McWilliam(Ed.), Rethinking pull out services in earlyintervention: A professional resource (pp.182-215). Baltimore: Paul H. Brookes.

Wright, T., & Nicholson, J. (1973).Physiotherapy for the spastic child: Anevaluation. Developmental Medicine andChild Neurology, 15, 146-163.


Name Purpose Areas Assessed Age Range Clinical Relevance

Ages and StagesQuestionnaires,(Squires, J., &Bricker, D.,1999)

Assessment,Evaluation andProgrammingSystem forInfants andChildren(Bricker, D.,1993)

BatelleDevelopmentalInventory(Newborg, L.,Stock, J. R., &Wnek, L., 1984)

Bayley Scales ofInfantDevelopment-II(Bayley, N.,1993)

• Determinedevelopmentthroughparental report

• Determine levelof functioning

• Develop inter-vention plans

• Monitor effectsof intervention

• Determine levelof development

• Determineeligibility foreducationalintervention

• Determine levelof development

• Determine eli-gibility for earlyintervention

• Communication• Gross motor• Fine motor • Adaptive• Personal-social

• Fine motor• Gross motor• Adaptive• Cognition• Social• Communication

• Personal-social• Adaptive• Motor• Communication• Cognition

• Cognition• Motor• Behavior

4-60months

1 month to3 years

1 month to 9 years

1-42 months

• Cost effectivemonitoring systemfor high riskinfants

• Administeredduring naturallyoccurring events,routines, andactivities

• Direct link toprogramming

• Allows forobservation or direct testing

• Takes intoconsideration taskadaptations/modifications

• Includesadaptations forchildren withdisabilities

• Screeningcomponent

• Limited number ofitems in eachdomain

• Predictive value ismoderate

• Most widely usedtool in infant research

Appendix

ADDITIONAL MEASUREMENT INSTRUMENTS USED BY PEDIATRICPHYSICAL THERAPISTS AND OCCUPATIONAL THERAPISTS

Continued


Name Purpose Areas Assessed Age Range Clinical Relevance

Bayley InfantNeurodevelop-mental Screener(Alyward, G.,1993)

The CarolinaCurriculum forInfants andToddlers withSpecial Needs(2nd ed.)(Johnson-Martin,N. M., Jens, K. A.,Attermeier, S. N.& Hacker, B. J.,1991)

MovementAssessment ofInfants (MAI),(Chandler, L. S.,Swanson, M.W., &Andrews, M. S.,1980)

PeabodyDevelopmentalMotor Scales(Folio, M., &Fewell, R., 2000)

• Screen forpotentialdelay orneurologicalimpairments

• Determinelevel ofperformanceacrossdimensions

• Provide auniformapproach tothe evalua-tion of highrisk infants

• Determinedevelopmen-tal level

• Neurologic• Receptive• Expressive• Cognitive

• Cognition• Communication• Gross motor• Fine motor• Self-help

• Muscle tone• Reflexes• Automatic• Reactions• Volitional

movement

• Reflexes• Gross motor• Fine motor

3-24months

0-36months

0-12months

0-72months

• Incorporatesneuromotoritems into devel-opmental scale

• Takes into con-sideration care-giver report

• Especially rele-vant for NICUfollow-up

• Criterion-referenced

• Curriculumcross-referencedto measurementinstrument

• Lengthy, greatdeal of handlingof the infant

• Risk profile for4-month-old

• Scoring allowscrediting ofemerging skills

• Activity cardsavailable but oflimited use

Screening Sensorimotor

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