Assessment of Vision, Hearing, Health, Sensory and Motor

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Assessment of Vision, Hearing, Health, Sensory
and Motor
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Vision Screening and Assessment

• Schools must state pass/fail criteria for vision
  screening in the district compliance plan.
• Criteria for diagnosis of partially sighted
  states a central visual acuity range of 20/70 to
  20/200 in the better eye with best correction.

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Vision Must Be Evaluated

• Some individuals with ASD may not respond to the
  typical screening instruments

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Vision Screeningcont.

• Criteria for blind states 20/200 or less in the
  better eye after best correction. 20/20 indicates
  a person can see a standard sized object for a
  standard number of feet away. A person can, for
  example, distinguish a letter or number at 20
  feet that an average person can distinguish at
  20 feet.
• 20/200 indicates a person can distinguish at 20
  feet what the average person can distinguish at
  200 feet.

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Visual Impairment

• May have normal central vision (acuity) with
  deficits in peripheral field (tunnel vision).
• Color Blind Usually not all or nothing may
  perceive different hues. Inherited trait.

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What Tests are Most Common?

• VISION Snellen Chart, Titmus, Keystone
• HEARING Beltone Audiometer
• MOTOR
• Bender Visual Motor Gestalt Test
• Developmental Test of Visual Motor
• Integration 4 (VMI), DTLA-4
• Bruiniks-Oseretsky Test of Motor Proficiency
• Motor Free Visual Perceptual Test

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Snellen Chart

• A Snellen chart is an eye chart used by eye care
  professionals and others to measure visual
  acuity. Snellen charts are named after the Dutch
  ophthalmologist Herman Snellen who developed the
  chart in 1862. ?

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Titmus Vision Screener

• The Titmus 2s Vision Screener is an instrument
  that can test for binocularity, visual acuity,
  color and depth perception and vertical and
  lateral phorias. the T2s model with perimeter can
  also test for peripheral vision in the horizontal
  field.
• Tests for acuity near, far, color,
• binocular functioning, and depth.

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Keystone

• The Keystone Ophthalmic Telebinocular is the
  accepted pioneer instrument of modern binocular
  vision testing and training.

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Visioncont.

• Functional vision assessment Response to
  environmental stimuli, colors, photographs, line
  drawings, details in the environment.

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Visual Behaviors

• Close scrutiny of visual details
• Prolonged staring
• Over/under response to visual cues
• Lacks visual attention
• Poor eye/face regard

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What Tests are Most Common?

• VISION Snellen Chart, Titmus, Keystone
• HEARING Beltone Audiometer
• MOTOR
• Bender Visual Motor Gestalt Test
• Developmental Test of Visual Motor
• Integration 4 (VMI), DTLA-4
• Bruiniks-Oseretsky Test of Motor Proficiency
• Motor Free Visual Perceptual Test

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Hearing Must Be Evaluated

• Hearing
• Tests such as audiograms and tympanograms can
  indicate if a child has a hearing impairment.
  Audiologists, school nurses and educators can
  evaluate the functional hearing of individuals by
  measuring responses such as blinking or staring
  or turning the head when a light is presented and
  response to environmental stimuli.

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Hearing Screening and Assessment

• Schools must state pass/fail criteria for hearing
  screening in the district compliance plan.
• ASHA (1985) recommends failure of pure tone
  hearing screening when individual fails to
  respond to screening levels presented in either
  ear.

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Hearing Screeningcont.

• ASHA has recommended for screening using
  frequencies of 500, 1000, 2000 and 4000 HZ at a
  HL of 20 DB.
• Hearing speech sounds in range of 500 to 4000
  crucial to understanding conversational speech.
• ASHA regards 20 DB as upper range of normal
  hearing for children.

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Hearingcont.

• Screen for failure in either ear after 20 DB
• Rescreen if failure, more complete functional
  hearing assessment audiogram or Tympanometery
  (screening of middle ear or eardrum) conducted by
  an audiologist.

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Beltone Audiometer
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Auditory Behaviors

• Non/over response to varying sounds response to
  same sound may change over time
• Seems not to hear

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Medical Assessment

• Assessment based on screening information, in
  depth social and developmental history.
• Medical tests are not required for an educational
  diagnosis of autism however, screening may
  warrant medical referral due to concomitant
  conditions and a detailed medical history and
  current health status is required.

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Medical Assessment

• Metabolic Screening Blood and urine lab tests
  measure how a child metabolizes food and its
  impact on growth and development.
• Magnetic resonance imaging (MRI) Magnetic
  sensing equipment creates, in extremely fine
  detail, an image of the brain.
• (Sicile-Kira, 2004)

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Medical Assessment

• Computer-assisted axial tomography (CAT scan)
• CAT scans are useful in diagnosing structural
  problems in the brain by taking thousands of
  exposures which are then reconstructed in great
  detail.
• (Sicile-Kira, 2004)

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Medical Assessment

• Genetic testing
• Blood tests can show abnormalities in the genes
  that could cause a developmental disability.
• Electroencephalogram (EEG)
• An EEG can detect tumors or other brain
  abnormalities. It also measures brain waves that
  can show seizure disorders.
• (Sicile-Kira,
  2004)

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Sensory

• Sensory input vision and hearing
• Sensory integration (OT assessment)
• Fine and Gross Motor

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Sensory and Motor

• Sensory differences are often an indicator of
  autism. Absence of differences does not
  necessarily mean that it is not autism.

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Sensory and Motor

• Consider and handle Motor skill assessment as you
  would any other student with suspected deficits
  in that area.

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Sensory and Motor

• Before the Review of Existing Data (RED)
• Contact your OT
• Complete the paperwork for a screening

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Who Should Assess Sensory and Motor?

• Trained Professionals
• Occupational therapist, physical therapist,
  adaptive PE and regular PE, nurse, medical
  professionals.
• Certain Procedures and instruments
• Speech and language clinicians, trained
  educational professionals.

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Sensory Assessments

• Sensory Profile School Companion
• --Important for students when Autism is
• suspected
• --Filled out by one or two school team
• members
• --Scored and interpreted by an OT

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Sensory Systems Involved

• Tactile Behaviors
• 1. Hypo/hyper response to touch and
• temperature
• 2. Unusual response to pain stimuli
• 3. Self-injurious behavior

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Sensory Systems Involved

• Olfactory Behaviors
• 1. Smells objects/repetitive sniffing
• 2. Licks inedibles

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Sensory Systems Involved

• Vestibular Behaviors
• Over/under response to gravity stimuli
• Whirling without dizziness

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Sensory Systems Involved

• Use of Objects
• May use objects inappropriately
• May become fascinated with parts of objects
• May engage in ritual behaviors (spinning,
  arrangements of objects, etc.)
• May form attachments to unusual objects such as
  sticks or string

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Sensory Systems Involved

• Stereotypic Behaviors
• May engage in unusual body posturing, finger
  flicking and toe walking
• 2. May use repetitive, stereotypic words and
  phases

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• These examples are only a partial listing of
  possible referral characteristics and are not
  intended to provide an exhaustive list.

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Motor Assessments

• Typical assessments for any student with fine
  motor concerns
• --Bruininks-Oseretsky Test of Motor Proficiency
• --Follow the advice of the OT
• --Fine motor observation done by the OT would be
  good for initial evaluation for Autism
• --OT will help support educational impact of
  sensory/motor differences (if there are some) in
  her observational report.

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Connections to Other Disciplines

• Sensory differences should be documented
  throughout the evaluation report. Possible
  places include
• - Classroom observations
• -Observational notes during formal
• assessments
• - Student history
• -GADS, GARS, ASDS, etc.

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What are Current Dilemmas in Sensory, Motor, and
Sensorimotor Assessment?

• Assessment does not always generate effective
  information for programming and therapy.
  Particular difficulty is noted with assessment of
  perceptual skills and the relationship of
  perceptual assessment to educational programming.

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What are Current Dilemmas in Sensory, Motor, and
Sensorimotor Assessment?

• Serious concerns are noted with technical
  adequacy of standardized tests, particularly with
  validity of perceptual tests.

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What are Current Dilemmas in Sensory, Motor, and
Sensorimotor Assessment?

• Trained professionals are not always available in
  school districts.
• Lack of training, understanding in regard to
  relationship of sensory and motor problems to
  academic difficulties.

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What are Current Dilemmas in Sensory, Motor, and
Sensorimotor Assessment?

• Sensory and motor deficits may adversely affect
  performance in assessment.
• Score and results may not be conducted outside of
  the educational setting and results may not be
  shared with educational professionals.

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What are Solutions to the Dilemmas in the Areas
of Sensory and Motor Assessment?

• Supplement results with standardized testing with
  informal/authentic and functional analysis.
• Relate programming and therapy decisions to
  behavior manifestations and environmental
  analysis of perceptual motor and sensory
  deficits. Conduct systematic observation across
  natural environments.

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What are Solutions to the Dilemmas in the Areas
of Sensory and Motor Assessment?

• Be sensitive to sensory and motor problems in
  assessment planning, select instruments and
  procedures that will as much as possible reflect
  ability.
• Provide appropriate assistive technology in the
  assessment process and include in your assessment
  an analysis of assistive technology needs.

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What are Solutions to the Dilemmas in the Areas
of Sensory and Motor Assessment?

• Coordinate assessment and instructional planning
  efforts. Obtain outside medical evaluations.
  Communicate with medical professionals outside
  the educational system.

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What are Solutions to the Dilemmas in the Areas
of Sensory and Motor Assessment?

• Have OT, PT, nurse and speech and language
  clinicians conduct assessment in natural
  classroom, school, home and community
  environments including systematic observation of
  the individual in those environments.