EVALUATION AND INTERVENTION PLANNING: TACTILE

SYSTEM
I.
Standardized Assessments
A. SIPT findings tactile discrimination abilities, kinesthesia, some
proprioception
SOMATOPRAXIS
Postural Praxis (PPr)
Oral Praxis (OP)
Graphesthesia (Gra)
Finger Identification (FI)
Localisation of tactile stimuli(LTS)
Manual Form Perception (MFP)

SOMATOSENSORY
Graphesthesia
Finger identification
Localization of tactile stimuli
Manual Form Perception

B. Touch Inventory- Royeen (1991)

C. Other assessment tools that include somatosensory items(MAP,TFST)
II.

Parent Interviews and Sensory Histories

A. Evaluation and Sensory Processing
B. Sensory Profile

III.

Structured and Unstructered observations

A. Reaction to Tactile input
1. Registration/awareness
2. Avoidance/ withdrawal
3. Modulation
4. Interaction with tactile experiences: orientation (localization),
discrimination(@ point, textures, temperature).

B. Use of somato-sensory input: Stereognosis, manipulation, weight

bearing, weight shifting
C. Changes in Arousal Level after touch
D. Response to other sensory experiences
E. Observations of tactile and sensory defensiveness
1. Tolerance to non-expected tactile input
2. Tolerance to self initiated input
3. Body areas on which tactile input is tolerated and type of input bieng tolerated

SnehRERC
Advanced Sensory Integration Workshop January 2014

4. Observation of behavior in relationship to presenting problems

INTERVENTION: TACTILE SYSTEM

I.

Generalised modulation disorder & tactile Defensiveness

A. Intervention Goals
1. Increase ability to maintain optimal arousal in the presence of tactile (or
any overarousing) input
2. Decrease over reaction to tactile input
3. Improve Social-emotional & organizational skills
4. Educate Parents & caretakers so they can help the child cope in specific
environments
5. Address fine motor skills if necessary
B. Intervention Strategies

Specific Intervention Strategies

Start with vestibular and
proprioceptive input, continue
with deep pressure, end with
touch if tolerated
Use play to shift attention. Allow
the child to feel sense of control
Avoid fleeting hands and light
touch
Use equipment to provide tactile
propiroceptive input. More
problem with fleeting touch
hands. Dont move hands a lot.
Try using surfaces vs. hands.
Hands change pressure while
surfaces are more constant.
Provide inhibitory input to activate
parasympathetic and decrease
sympathetic reactivity. Use deep
pressure, Proprio, deep breathing,
positive attitude.
MODIFY YOUR SIOCIAL INTERACTION
WITH THE CHILD:
Respect the childs personal space
Do not impose
Allow the child to have control
over the tactile input he/she
receives- expect a response
Gentle and firm intervention style

Context relevant intervention strategies

MODIFY THE PHYSICAL ENVIRONMENT:
Reduce sensory overload in the
environment: lower voice, use
natural light, work in small spaces
at first
Avoid activities that include light
touch
Provide inhibitory input such as
deep pressure and proprioception
Give caregiver the suggestion to
wash clothing before the child
wears it
Teach caregiver to avoid dressing
the child in tight clothing.
SENSORY DIET:
Place the child between two large
pillows, roll him/her down an
incline, roll the child inside a
blanket or sheet and brushing
body
Wrestling with dad
Inhibition throughout day-chew
tubes, blowing, chewy snacks,
theraband, theratube, weights

SnehRERC
Advanced Sensory Integration Workshop January 2014

Imperatore Blanche 1996

Fixating on the therapists face when

stopped
Provide activities that promote
bilateral motor co-ordination
While on the swing pull on the
ropes or provide a piece of
equipment to bump on, to change
direction, speed and tempo of
your swing movements.

Sensory diet:

Modify your social interaction with the

child:
Imperatore Blanche 1996
E.
1.

POSTURAL MECHANISMS
Intervention Goals:
Improve overall balance and postural control
Improve ocular motor skills
Improve organization of behavior

2. Intervention strategies
SPECIFIC INTERVENTION STREATEGIES
Consider the type of input being
provided in relationship to the postural
mechanism being facilitated
Linear movts affect extension
against gravity
Rotatory movts affect ocular
motor control
Use NDT principles to facilitate adequate
postural responses
Provide activities that require maintain a
stable visual field while moving.

CONTEXT RELEVANT INTERVENTION

STRATEGIES
Modify the physical environment:
If the child has a rounded upper
back, raise the surface he/she is
writing on
Sit child on the ball during writing
activities so he/ she can provide
self with input
Have child do homework in prone
on the floor
Have child do work on a table top
easel or vertical surface.

Modify your social interaction with the

Sensory Diet:

SnehRERC
Advanced Sensory Integration Workshop January 2014

child:
IMperatore Blanche,1996

Do activities that require

alternating patterns; pulling on a
rope hand over hand, tug of war,
wheelbarrow, swimming, etc.
Extension against gravity and
proximal joint stability in the neck
and shoulder girdlearea eg.
Swinging in prone while propelling
on the floor or by pulling a rope,
or working in prone on the mat.
Use rhythmic songs, rhymes or
clapping games during the
movement activities.

Sensory diet:

Modify your social interaction with the

child
Imperatore Blanche, 1996

D.Poor registration or hyper-responsiveness to movement

1. Intervention goals:
Improve postural control and special orientation
Improve organization of behavior
2.Intervention Strategies
SPECIFIC INTERVENTION STRATEGIES
Provide opportunities for

CONTEXT RELATED INTERVENTION

STRATEGIES
Modify the physical environment

SnehRERC
Advanced Sensory Integration Workshop January 2014

movement experiences
Decrease amount of time that the
child is expected to hold still
Provide activities that promote
extension against gravity and
proximal joint stability in the neck
and shoulder girdle area
eg:swinging in prone by propelling
on the floor or working on prone
on the mat
Work on maintaining a stable
visual field while moving eg:
swinging and hitting a target, or
rotating and then

II.
Hypo-responsiveness to touch & tactile discrimination disorders
A. Intervention Goals:
Improve body schema
Gradually increase the complexity of tactile discrimination abilities:
localization, two point discrimination, directionality, stereognosis(haptic)
Improve motor planning , organization of behavior, and peer interaction when
necessary.
B. Intervention Strategies
SPECIFIC INTERVENTION STRATEGIES
Use brushes that provide different
types of light touch eg. Paint
brushes, scrub brushes etc
Use equipment that provides
pressure such as paint rolls,
elastic bands etc
Roll the child in a sheet
Cover the equipment with
interesting textures such as
carpet, towels etc
Present activities that provide
tactile input on childs whole body

SPECIFIC INTERVENTION
STRATEGIES(contd)
Have a box with the different
textures that is easy to pull out
and incorporate into other
activities. Include vibators,
feathers and some of the material
mentioned above.
Have differebt types of vibratorslet the child use them to make
designs on his/her skin.
Look for commercially available
tactile discrimination games eg

SnehRERC
Advanced Sensory Integration Workshop January 2014

such as container with balls or

Styrofoam, big soft pillows etc
Provide activities that encourage
discrimination i.e objects inside
bin full of beans, sand or
Styrofoam
When inside a container full of
balls encourage the child to
actively move and change
positions by slightly moving the
container etc
Use shaving cream, powder, finger
paint, lotion, soap gel etc and
encourage fine motor coordination and tactile
discrimination by dipping fingers
into substance and writing on the
skin.
Pretend shaving face or applying
clown make up and encourage the
child to apply tactile input on his
face. Use a mirror
Encourage localization of tactile
input, use stickers on arms or legs
and encourage them to find them.
Imperatore Blanche.1996

tactile dominos, tactile puzzle etc

Provide play dough that offers
different textures and resistance
i.e. homemade silly putty,
theraputty, slime etc.
Play games where the child needs
to move through different
textured equipment eg small
tunnel with carpeted equipment.
Use battery operated toothbrush,
regular toothbrushes, different
food consistencies etc. to provide
tactile input to the oral area.

EVALUATION AND INTERVENTION PLANNING:

PRORIOCEPTIVE AND KINESTHETIC FUNCTIONS
I. Standardized assessments
A. SIPT- kinesthesia, some propioception
TESTS with proprioceptive/kinesthetic equipments
Kinesthesia
Standing and walking balance
Manual form perception
Graphesthesia

SnehRERC
Advanced Sensory Integration Workshop January 2014

Postural Praxis
Oral praxis
I.

Parent interviews & sensory histories

A. Evaluation of sensory processing
B. Sensory profile
III.Structured and unstructured observations
A. Clinical observations (blanche 2002)
1. Sequential finger touching
2. Slow ramp movbements
3. Schilders arm extension test
4. Jumping jacks, skipping
5. Balance
B. Reaction to proprioceptive and kinesthetic experiences
1. Weight bearing and weight shifting( ankle strategies, locking joints,
proximal joint stability)
2. Change of position
3. Postural background and postural adjustments
4. Sensory preferences
5. Use of force, co-ordination, timing, spatial awareness, fixing

INTERVENTION: PROPRIOCEPTIVE SYSTEM

Proprioceptive Related Disorders
A.

B.

C.

Intervention goals- discrimination/hyperresponsiveness ??????

Improve ability to discriminate force
Improve body scheme
Provide home program
Address motor planning or defensiveness if necessary
Intervention goals- using proprioception as a modulator
Use proprioception to help organize self regulation
Provide home programs/ classroom programs
Intervention Strategies

SPECIFIC INTERVENTION STRATEGIES

Use we ights during the session.

CONTEXT RELATED INTERVENTION

STRATEGIES
Modify the physical environment

SnehRERC
Advanced Sensory Integration Workshop January 2014

Have a weighted jacket, bean

bags of different weights etc.
Use the opportunity when in need
to move the equipment and ask
the child to help push , pull and lift
Encourage prprioceptive input
through co-contraction, wheel
barrel, quadruped, prone on
elbow. Make sure it is active
proximal joint stability.
When in weight bearing facilitate
weight shifts by moving the child
lightly to activate muscles.
Push and pull games, push the
adult while she/he is sitting ona
scooter board or swing.
Play tug of war.
Use trapeze to pull child when
he/she is on a scooter board. Make
sure that the child is actively
pulling by encouraging elbow
flexion during activity.
Provide play dough that offers
high resistance, . theraputty can
be help ful.
When riding a moving piece of
equipment, provide uneven
vestibular stimulation eg. Jerky,
bumpy road etc so that the child
needs to use proximal joint
stability.

Sensory diet

Use inner tubes in games such as

bumper cars or rolling inside a
stack of inner tubes to provide
prop and tactile input
Have climbing equipment that
children can use eg. Steep soft
ramp leaned against wall, ropes,
ladders etc pressure, prop, deep
breathing, positive atitude
Imperatore Blanche, 1996

SnehRERC
Advanced Sensory Integration Workshop January 2014

II.

Intervention of Combinations

ADDRESSING SOMATOSENSORY ISSUES ACROSS THE LIFESPAN

I.
A.
1.
2.
3.
4.
5.
6.
7.

Intervention with the young child

Observations
Weight bearing and weight shifting
Hand skills
Feeding preferences
Activity level, arousal level
Play
Motor planning and body awareness
Research in NICU

EVALUATION & INTERVENTION PLANNING VESTIBULAR

SYSTEM
I.
II.
III.

Standardized assessments : SIPT findings-PRN

Parent Interviews & sensory Histories- Evaluation of sensory
processing
Structured and unstructured observations

ASSESSMENT OF VESTIBULAR
PROCESSING
Postural control
1. Righting reactions

RELATIONSHIP TO FUNCTION &

DYSFUNCTION

SnehRERC
Advanced Sensory Integration Workshop January 2014

2.
3.

Protective reactions
Equilibrium/balance reactions
Reactive
Anticipatory
Interaction with proprioceptive
and visual processing
Extension against gravity and the
relationship to flexion against gravity
Ocular motor control during movement
Bilateral motor control and laterality
Response to linear movement
Response to rotatory movement
Responses to changes in vestibule/
prop/visual sensation in relationship to
space and gravity
1. Tilt back in space
2. Open space
3. Objects approaching
4. Movement into space(jumping
forward)
5. Careful movement

BC. Proprioceptive engagement encouraged

1. Increases muscle tone and postural control
2. Helps modulation of vestibular sensation

SnehRERC
Advanced Sensory Integration Workshop January 2014

D. Vestibular activities can be used to modulate arousal such as fast & intense
for alerting and slow and rhythmic for calming
1. CAUTION- Vestibular sensation is powerful. It affects arousal and ANS
responses. Watch for ANS responses; pallor, nausea, drowsiness, papillary
dilatation, shortness of breath.
2. Vestibular sensations alone do not elicit seizures- however during movement,
the optokinetic effect can elicit seizures through the visual, light/dark pattern.
3. If the child becomes drowsy and wants to sleep or pretend to sleep, engage
the child in an active game and stop swinging for a while until the child is
alert again.

E. Use of vestibular can do the following:

1. Increase tone.
2. Increase motivation during challenging activities.
3. Increase vocalization
4. Increase eye contact
5. Increase general alertness

F.
1.
2.
3.
4.
a.
b.

6.
7.
8.
9.

Observe for adaptive responses in the following areas:

Arousal, alertness and attention
Spontaneous appropriate vocalizations
Increase ability to hold on and stay put
Oculomotor control and visual motor control
Involuntary eye movements, stabilizing the eyes during movement
Voluntary eye movements- moving the eyes relative to the head and body
positin, social eye gaze
Postural eye control
a. Extension against gravity
b. Proximal joint stability
c. Righting and equilibrium reactions with and without vision
Bilateral motor co-ordination
Improved rhthymicity
Increased lateralized skills
Projecting actions and sequences in time and space

B.
1.

2.

Intolerance to movement
Intervention goals
Improve tolerance of movement activities
Improve organization of behavior
Intervention strategies

5.

SPECIFIC INTERVENTION STRATEGIES

CONTEXT RELEVANT INTERVENTION

STRATEGIES

SnehRERC
Advanced Sensory Integration Workshop January 2014

 Respect the childs fears

Do not force the child to move
especially with rotation or
rhythmic rolling movements
Minimize vestibular sensationstart with slow head turning and
then linear movement against
gravity
Give the child control over his/her
movements in space
Provide opportunities for head
movement with resistance
Provide opportunities for engaging
in activities with increased
proprioception
Allow child opportunities to
visually orient in space during
movement
Encourage child to stop when they
dont feel well-never push it.
Modify your social interaction with the
child:
Respect childs personal space
Do not impose
Imperatore Blanche, 1996

Modify the physical environment

Sensory diet

C. Bilateral Motor co-ordination

1. Intervention goals
Improve rhythm and sequencing of movements
Improve co-ordinated use of the two sides of the body
Improve organization of behavior
2. Intervention strategies
SPECIFIC INTERVENTION STRATEGIES
Do acitivities that require
symmetrical patterns; pumping
the swing, pulling on a trapeze
with both UE, propelling a scooter,
catching a ball, throwing a ball
with both UE, rowing etc.

CONTEXt RELEVANT INTERVENTION

STRATEGIES
Modify the physical environment

INTERVENTION
I.

General Intervention Principles

SnehRERC
Advanced Sensory Integration Workshop January 2014

A. Sensory Input
1. Vestibular sensations increase for hyporesponsiveness, decrease for
intolerance to movement.
2. Improve spatial awareness of the body through the use of vestibular
sensations coupled with auditory, visual, proprioceptive sensations.
VARIABLES RELATED TO VESTIBULAR SENSATIONS
Types of vestibular
Environmental
Client Factors
sensations
condition
Linear(vertical &
horizontal)
Head position
Rotatory (around in
Prone
circles?)
Supine
Axial( around the
Standing
body)
Quadruped
Orbital( in an axis
Head tilt
outside of the body)
Side lying
Arc
Inverted(extremely
Corealis
intense)
( simultaneously
experiencing atleast
Static
three of the above
Transient
types of input eg. Up
Visual Field
In Motion
and down, rotator and Stable
orbital)
Moving
Speed
Intensity
Body- Static
Duration
Moving
Rhthymicity
Physical
Passive
Stop and Start
Environment
Active
Chnages in direction
Stable Moving
Smith Roley, 2002
B. Facilitae active engagement whenever possible
1. However, if child is seeking vestibular sensations, often he/she is
unable to provide him/herself the intensity that he/she needs and
will need some amount of passive rotation before during and after
challenging activities.
2. If the child is craving vestibular sensation especially fast rotation,
provide it by starting and stopping frequently to check the childs
adaptive responses. If the childs responses are improving,
continue. If their language, motor skills or physiological signs
deteriorate, change the activity.

SnehRERC
Advanced Sensory Integration Workshop January 2014