Roseann C. Schaaf, Janice Posatery Burke, Ellen Cohn, Teresa A. May-Benson, Sarah A. Schoen, Susanne Smith Roley, Shelly J. Lane, L. Diane Parham, Zoe Mailloux; State of Measurement in Occupational Therapy Using Sensory Integration. Am J Occup Ther 2014;68(5):e149-e153. doi: 10.5014/ajot.2014.012526.
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© 2019 American Occupational Therapy Association
This article presents the current state of measurement in the area of sensory integration within the field of occupational therapy in three areas: (1) phenotypic characterization, (2) intervention adherence and dosage, and (3) outcome measurement. The need for additional measurement tools in all three areas is addressed. In regard to outcome measurement of occupational therapy using sensory integration, the use of both qualitative and quantitative methods to obtain outcome data is recommended. Further, a strategy is recommended for obtaining outcome data from direct report from the child or other stakeholder.
What assessment tools can occupational therapy practitioners use to identify and describe the range of sensory and motor characteristics (i.e., phenotypic characterization) in children with difficulty processing and integrating sensation?
What measurement tools are needed to ensure that researchers and clinicians stay true to the theoretical propositions of sensory integration intervention and provide the correct dosage of intervention?
How can practitioners identify the outcome measures that are the most sensitive and meaningful to the children and families who seek occupational therapy intervention?
Additional measures are needed to ensure a comprehensive assessment of the sensory and motor factors that may be influencing function and participation. Key areas that would benefit from additional development include examiner-administered measures of sensory modulation to complement the currently available caregiver and teacher questionnaires; broader assessment tools of sensory perception and discrimination, including expanded assessment of proprioceptive and vestibular functions; formal standardized assessments of posture and balance; and measures of specific areas of praxis (e.g., ideation, motor planning).
Assessment measures need to be developed to address a wider age range. Mandates for early identification indicate that reliable and valid measures of sensory integration and praxis for young children are essential, yet few adequate tools are available. In addition, measures for adolescents and adults are currently lacking, resulting in this population being underserved.
Neurophysiological studies are needed to define the underlying neural functions that may explain diverse patterns of sensory integration difficulties, to expand our repertoire of intervention strategies, and to measure changes in neural functions that may result from intervention.
Although much has been accomplished with regard to measurement of fidelity to the core principles of OT–SI, expansion of this research is needed to develop measures that will allow application of this approach in varied settings and with different populations.
Studies are needed that evaluate dosage to understand the best candidates for intervention and the appropriate intensity and frequency of intervention.
Practitioners and researchers need to continue to identify outcomes that are meaningful to clients and sensitive to the changes observed after intervention. Although measures at each level of the ICF have been used in existing studies, more assessments are needed at every level. Proximal outcomes that measure changes in sensory and motor behaviors associated with sensory integration and neural functioning are needed to determine whether the changes in function and participation observed are concomitant with changes in nervous system functioning. Measures at the activity level of the ICF are also needed and may include specific performance-based skills such as improved balance, posture, or praxis or changes in daily activities. Distal outcome measures of participation are needed that are sensitive and meaningful to families. Consumer satisfaction, quality of life changes, longitudinal effects, cost-effectiveness, and caregiver and societal burden are all important outcomes that need focused attention.
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