Course 2 - SI Evaluation & Clinical Reasoning:

From Identification to Intervention

Module 3 - Sensory Integration and Praxis Tests
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 Covered Topics
• Basic concepts of standardized tests

• Psychometric Concepts Related to Test Development and

Standardization

– Validity of the SIPT

– Reliability of the SIPT
– Results of Factor and Cluster Analyses using the SIPT

• Understanding the SIPT Test Report

• Incorporating information provided by the SIPT tests in clinical

practice

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Review SIPT descriptions in Notebook
Go to Appendix 3.3 (p.83-116)

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Basic Concepts of Standardized
Assessments

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 Basic Concepts

• Mean– M, µ, X
– The expected value of a variable
– Sum all entries divided by number of entries

• Standard Deviation (see next slide)

– A measure of variability

• Standard Scores – SD, z-score

– Converting a variable so it has a mean of 0 and a
standard deviation of 1
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Probability Distribution

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A B

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 Correlation Coefficients
• A descriptive statistic, measures the degree of
relationship between two variables

• Pearson product‐moment correlation coefficient is

most common, but there are others (ie. Intraclass)

• Correlation referred to as “r” value

• When scores on two variables are paired, they are

“bivariate”

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 Characteristics of Correlations
• Scores range from ‐1 to +1

• A perfect positive correlation = 1

• Positive correlations occur when scores on one

variable increase, scores on the other increase

• A perfect negative correlation = ‐1

• Negative correlations occur when scores on one

variable increase, scores on the other decrease

• No correlation is 0
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 Correlation Interpretation
To help to interpret correlations, in the SIPT there are
three types of correlations The significance of the
correlation varies dependent on what type of relation
you are looking at:

– 1. Between tests

– 2. Reliability

– 3. Factor loading

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 Examples of Correlations Between the
SIPT Tests
• Finger Identification (localization) correlates with CPr (.49),
DC (.41), GRA (.38), SWB (.37), and P Pr (.35) in children
with dysfunction

• Graphesthesia correlates with SPr (.54), Opr (.50), CPr (.46),

and PPr(.41) in children with dysfunction

• Manual Form Perception (haptic perception) correlates with

DC (.40), CP (.42), SWB (.39), SPr (.38), and Graphestesia
(.37) in children with dysfunction
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 Psychometric Properties of Standardized
Assessments
• Validity: the extent to which a test measures what it says
it measures

• Reliability: the degree of accuracy and confidence

• Factor Analyses: used to identify underlying patterns in

the data

• Cluster Analyses: used to form groups with similar

characteristics

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 Validity
• The extent to which an instrument measures what it
claims to measure

• Most important characteristic

• Establishment of adequate reliability is essential, but

high reliability does not guarantee high validity

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 Types of Validity
• Data Free
– Face validity: based on superficial examination of the
instrument
– Content validity: based on theory or rationale

• Data Based
– Construct and Criterion Validity
– Data from the SIPT from 1965‐1998 informed Ayres
SI theory and understanding patterns of dysfunction

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 Construct Validity
• Construct validity: Does the test measure what it
says it measures (factor analysis)

– Discriminant validity: Using a matched sample

of typically and atypically developing children,
all tests of the SIPT had discriminative validity at
least at the p<.01 significance level
– See Table 17 in the SIPT manual

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 SIPT Means and Standard Deviation for
Different Diagnostic Groups (Table 17)
Autistic Learning Brain Mental SI Spina Bifida Reading Language Cerebral Normal
Disabled Injured Retardation Dysfunction Disorder Disorder Palsy
(n = 7) (n =195) ( n = 10) (n = 28) (n = 36) (n = 21) ( n = 60) (n = 28) (n = 10) ( n = 136)

Test M SD M SD M SD M SD M SD M SD M SD M SD M SD M SD
SV -.36 .92 -.71 .85 -1.03 1.01 -1.51 .97 -.67 1.04 -.74 .63 -.52 .92 -.75 1.15 -.85 .37 .20 .80
FG -.34 1.73 -.75 1.07 -1.31 1.29 -1.73 1.68 -.29 1.05 -1.09 .86 -.92 .79 -.81 1.16 -.68 .88 .32 1.06
MFP -1.08 1.27 -1.02 1.23 -1.90 1.30 -2.79 0.32 -.46 .99 -1.91 1.25 -.99 1.10 -1.17 1.14 -.65 .21 .15 .86
KIN -.67 .87 -1.09 1.36 -1.69 1.59 -2.73 0.55 -.60 1.08 -1.12 1.30 -1.30 1.02 -1.01 1.48 -.60 1.54 .16 .83
FI -.24 1.07 -1.02 1.03 -.80 1.01 -1.90 0.89 -.73 1.05 -.53 1.06 -1.02 1.02 -1.04 1.00 -1.60 1.28 -.10 .97
GRA -.96 .84 -1.37 1.14 -1.57 1.15 -2.42 0.69 -1.09 1.06 -1.94 .69 -.63 1.18 -1.17 1.01 -1.28 1.47 -.12 1.03
LTS -.54 .31 -.65 1.20 -1.18 1.09 -1.63 1.77 -.61 1.20 -1.38 1.12 -.33 1.07 -.86 1.04 -1.80 .94 -.28 1.15
PrVC -2.09 1.02 -1.40 1.36 -1.58 1.50 -3.00 .00 -.49 1.25 -.99 1.24 -1.01 1.32 -1.74 1.38 -.63 1.52 .23 .75
DC .06 1.66 -1.60 1.12 -1.43 1.35 -3.00 .00 -.86 1.05 -2.05 1.13 -1.24 1.27 -1.33 1.11 -2.33 .99 .26 .99
CPr -.72 1.11 -.91 .95 -.83 1.02 -2.17 .53 -.46 .95 -1.18 1.09 -.60 .88 -.78 .93 -1.00 .95 .24 .67
PPr -2.46 .82 -1.44 1.13 -2.28 1.00 -2.74 .61 -1.05 1.33 -1.59 .83 -1.42 1.01 -.92 1.08 -1.73 1.07 -.31 .96
OPr -1.84 .99 -1.37 1.17 -2.34 .88 -2.67 .66 -.77 1.23 -2.05 .79 -.70 1.10 -1.30 .99 -1.58 2.41 -.14 .98
SPr -2.38 .93 -1.48 .98 -1.56 1.11 -2.36 .74 -1.17 .87 -1.13 1.00 -.78 .83 -1.36 .84 -.93 .76 .21 1.01
BMC -2.18 .61 -1.15 .99 -1.68 .91 -1.85 .49 -.71 1.16 -1.18 .81 -.58 .92 -1.47 .54 -1.23 .86 .09 .95
SWB -1.57 1.35 -1.58 1.11 -2.17 1.17 -2.87 .31 -1.46 .98 -2.98 .11 -.61 1.01 -1.31 1.00 -2.73 .32 .05 .93
Mac -.37 .81 -1.04 1.02 -1.97 .97 -2.44 .83 -.89 1.00 -1.23 1.16 -.47 .86 -.67 1.00 -1.98 .83 .16 .68
PRN -.70 .90 -.12 1.22 1.09 1.46 -1.04 1.44 -.84 1.00 - - -.21 .80 -.05 0.77 .19 .31 .05 .95
 Criterion Related Validity
• How the test relates to an outcome: concurrent and
predictive

• Concurrent: Comparison with other tests measuring

same construct
– K‐ABC: SIPT measures of sequential processing correlated highly with
K‐ABC items of sequential processing (Ayres, 1989)
– SIPT tests of Design Copying (DC) and Constructional Praxis (CPr)
correlated highly with other tests of constructional abilities (Cermak &
Murray, 1991)
– SIPT test of Postrotary Nystagmus (PRN) correlated with other
measures of central vestibular functioning (Wiss & Clark, 1990)

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 Predictive Validity

Parham (1998) found relationships

of SI functioning to academic
achievement in elementary school
aged children; praxis and visual
perception at ages 6‐8 were
significant predictors of arithmetic
and reading four years later when
statistically controlling for the
influence of intelligence

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Studies Related to Age, Gender, and Ethnicity

• Age trends are reported for all tests (Ayres, 1989)

• Ethnicity: Varying performance on tests of the SIPT

were reported but little can be concluded except for a
lower score on the tests of Praxis on Verbal Command
for children whose primary language is something other
than English (Ayres, 1989)

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 Studies Related to SES
• The SIPT analyses did not address varying
performance on the tests within different
socioeconomic groups

• Bowman and Wallace (1990) examined differences

in hand size and strength, vestibular function,
visuomotor integration and praxis in preschool age
children as a function of socioeconomic status.
Various analyses revealed significant differences in
all of these areas except vestibular function

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Reliability of the SIPT

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 Definition of Test Reliability
• Measures the degree of stability, consistency, and accuracy
in a test; indicates how confident we can be in a test score

• Acceptable reliability
– .80 for clinical decision making
– .70 for research purposes

• What lowers reliability?

– Subject variability
– Measurement errors
– Unstable traits
– Number of test items

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 SIPT Reliability: Inter-rater

• In a sample of 63 children, the inter‐rater reliability

between 8 SIPT examiners for all tests was between
.94‐.99 (Ayres, 1989)

• In a study using SIPT scores on 2 cases, therapists rated

the cases for presence or absence of SI dysfunction and
for specific patterns. Inter‐rater reliability was
moderate to high for presence of SI dysfunction but
less for specific patterns. Results showed that clinical
observations are necessary for reliable distinctions
among dysfunctional patterns (Asher, Parham, & Knox, 2008)
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 SIPT Reliability: Test-retest
• The praxis tests as a whole had the highest test‐retest reliability

• The four lowest are KIN, LTS, FG, and PRN

• Kinnealey & Wilbarger (1993) conducted test‐retest reliability

on 27 children, ages 4.6 – 10.0 who had been born at high risk
and hospitalized in a NICU. Individual test‐retest reliability
ranged from .32 (KIN) to .89 (DC). Test reliability on the entire
SIPT was .93; on the form and space tests, .73; on the somatic
and vestibular tests, .83; on the praxis tests, .90; and on the
bilateral integration and sequencing tests .88

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SIPT Reliability: Additional Considerations
• If test‐retest reliability is low, caution is needed when
giving the tests on multiple occasions

• In general, longer tests will have higher reliability as a

greater number of items reduces variability

• Standard error of measurement: an estimate of the

amount of error in a test

• Related to test reliability – the higher the reliability, the

lower the standard error
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 Major Estimated SEM SEM Band:
Test Score True Score Lower Upper
Space Visualization (SV) 0.72 0.51 0.55 -0.57 1.58
Figure-Ground Perception (FG) 0.43 0.24 0.66 -1.06 1.54
Manual Form Perception (MFP) -0.05 -0.04 0.55 -1.11 1.04
Kinesthesia (KIN) -3.00* -1.55 0.71 -2.93 -0.16
Finger Identification (FI) -2.41 -1.78 0.51 -2.78 -0.78
Graphethesia (GRA) -0.73 -0.53 0.52 -1.55 0.49
Loc. of Tactile Stimuli (LTS) 0.35 0.19 0.69 -1.16 1.53
Praxis on Verb. Command (PrVC) -0.36 -0.32 0.33 -0.97 0.33
Design Copying (DC) -0.77 -0.71 0.26 -1.23 -0.20
Contructional Praxis (CPr) -0.45 -0.31 0.55 -1.39 0.76
Postural Praxis (PPr) -1.56 -1.34 0.37 -2.07 -0.61
Oral Praxis (OPr) -2.74 -2.46 0.32 -3.00* -1.84
Sequencing Praxis (SPr) -0.19 -0.16 0.40 -0.94 0.63
Bilateral Motor Coord. (BMC) -0.20 -0.17 0.42 -1.00 0.67
Standing & Walking Balance (SWB) -1.51 -1.29 0.39 -2.05 -0.53
Motor Accuracy (MAc) -1.17 -0.99 0.39 -1.75 -0.24
Postrotary Nystagmus (PRN) 1.12 0.54 0.72 -0.88 1.95

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Factor Analyses During Development of
the SIPT

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 Definition of Factor Analyses
• Factor analysis is a commonly used statistical tool used to provide a simpler
interpretation of a large body of data

• Explains observed relationships between variables as due to their relationship to

unknown variables (factors)

• Factor loading: How much an individual test contributes to the factor, or the
strength of the relationship between the factor and the observed variable

• Commonality: How much variance of this test is explained by common underlying

factors

• Specificity: How much variance is not explained by factors; i.e. what is specific only
to that individual measure

• Factor solution: The number of factors as “best fit” can be determined by

statistical program; researcher can also ask for various numbers of factors

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 More on Factor Loading
• Factor loadings are a type of correlation

• A factor loading of .35 is considered to be

have a moderately high factor loading
(correlation) and a factor loading of .50 is
considered to be a high factor loading
(correlation)

• On the SIPT there are 17 tests and 136

correlations

• This data is reduced to give us a better

understanding of the relationships between
tests

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 SIPT Factor Analysis Summary
Visuo Somato BIS Somatosensory Dyspraxia on Other PRN
Praxis Praxis Related Verbal Command related
CPr .68 OPr .80 KIN .63 PRN .61
Typically SV. .67 BMC .70 MAc .57 LTS .49
Developing DC .63 PPr .54 PPr .37 FI .44
N=1750 MFP .56 GRA .54 KIN .38
FG .52 SPr .53
PrVC .43 SWB .39
FI .38
MAc .78 PPr .89 SPr .78 LTS .83 PRN .73
SI/LD DC .67 CPr .54 BMC .69 KIN .74 PrVC .‐59
N=125 SV.64 OPr .51 GRA .57 OPr .37 FG ‐.36
FG .54 GRA .42 SWB .54
CPr .38 OPr .40
FI .37 MFP .38
SV .77 OPr .87 LTS .91 PRN .86
Combined FG .76 GRA .72 KIN .48
N=293 DC .73 BMC .71
MAc .65 SPr .70
CPr .53 SWB .57
PrVC .53
PPr .48
(Ayres 1989) 32
 Factor Analyses Patterns
• Between 1965 & 1989, Ayres conducted factor analyses which
revealed the following patterns
– Tactile & motor planning deficits
(1965, 1966, 1969, 1972, 1977 & 1989)
– Visual perception/visual praxis deficits
(1965, 1966, 1969, 1972, 1977 & 1989)
– Vestibular, postural & bilateral deficits
(1965, 1966, 1969, 1972, 1977 & 1989)
– Tactile defensiveness & hyperactivity/distractibility
(1965, 1966, 1969, 1972)
– Other factors (auditory language; somatosensory perception)
seen in some studies
(1969, 1972, 1977, 1989)
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 Limitations of Factor Analyses
• Large number of assumptions are required of the
factor model is sometimes not realistic on an
actual set of data

• Different investigators may use the same set of

data with a different rotation method to achieve
different results

• Factors are not always easy to interpret

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 Additional Factor Analytic Studies
• Mulligan (1998)

• Mailloux, Mulligan, Smith Roley, Blanche, Cermak,

Coleman, Bodison and Lane (2011)

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Ayres 1989 Mulligan 1998 Ayres 1989 Mulligan 1998 Mailloux, Mulligan, Smith Roley
Visuopraxis Visuopraxis Somatopraxis Somatopraxis et al 2011
Visuo & Somato‐dyspraxia
SV SV SV
MFP MFP MFP
DC DC DC
CPr CPr CPr
Mac Mac
FG
PrVC PrVC
PPr PPr PPr
OPr OPr
BMC
SPr
GRA GRA

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Ayres 1989 Bilateral Mulligan 1998 Mailloux, Mulligan Smith
Integration & Bilateral Integration Roley, et al 2011
Sequencing & Sequencing/ Vestibular Bilateral Integration
Postural Ocular & Sequencing
OPr (OPr) OPr

SPr SPr SPr

GRA (GRA)

BMC BMC BMC

SWB SWB SWB

MFP PRN

MAc

KIN (KIN)
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Ayres 1989 Mulligan 1998 Mailloux, Mulligan Smith
Somatosensory Related Somatosensory Related Roley, et al 2011
(Vestibular & (Somatosensory Somatosensory Related
Somatosensory; Processing) (Tactile and Visual
Somatosensory) Discrimination)
LTS LTS LTS

KIN

OPr (OPr)

FI FI FI

GRA

PRN FG

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Cluster Analyses During SIPT
Development

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 Cluster Analysis
• Purpose: like FA‐allows for interpretation of large
amounts of data

• In factor analysis individual test scores are compared

and grouped

• In cluster analysis, the entire set of scores (i.e. the

main scores plotted on the graph) represent in
subject in the analysis

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 Cluster Analysis (cont’)
• Cluster analysis then considers sample of subjects
(children), each measured on a number of variables
(SIPT tests), and groups “similar” subjects

• Cluster analysis starts with one large group and then

statistically begins “grouping” based on consideration
of all scores for the subjects

• A cluster is a group of entities (children in the SIPT

analysis) that are alike and are also different from
other clusters

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 6 Cluster Groups
• Low Average Bilateral Integration and Sequencing –
19% of children (n = 55; 36 normal, 11 LD, 8 SI)

• Generalized Sensory Integrative Dysfunction –

12% (n = 34; 2 normal, 28 LD, 4 SI)

• Visuo‐ and Somatodyspraxia –

12% ( n = 35; 13 normal, 13 LD, 9 SI)

• Low Average Sensory Integration & Praxis –

24% (n = 71; 54 normal, 13 LD, 4 SI)

• Dyspraxia on Verbal Command –

10% (n = 29; 6 normal, 21 LD, 2 SI)

• High Average Sensory Integration & Praxis –

24% (n = 69; 65 normal, 3 LD, 1 SI)
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 Cluster Analysis and SIPT Testing
• The nature of cluster analysis, in contrast to factor analysis, allows
comparison of new cases to identified groups

• WPS test report includes comparison of child tested to the 6 cluster

groups

• Calculation results in a “D squared” value

• If D s squared value is 1.0 or less in comparison to any of the 6 cluster

groups, the child tested is statistically “like” those groups

• Child can be “like” one group, more than one group or no groups

• More important to understand the patterns identified in the groups

than to use D Squared figures in individual interpretation

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1. Low Average Bilateral Integration and Sequencing 1.41
This group tends to have average SIPT scores, but low average scores on Standing and Walking Balance,
Bilateral Motor Coordination, Oral Praxis, Sequencing Praxis, and Graphesthesia.
2. Low Average Sensory Integration and Praxis 1.80
This group scores in the low average range on all SIPT.
3. Generalized Sensory Integration Dysfunction 1.88
This group tends to have below average scores on all SIPT subtests and has both practic and somatosensory
deficts.
4. Dyspraxia on Verbal Command 1.43
This group is likely to have severe difficulty with Praxis on Verbal Command. This group has the highest
Postrotary Nystagmus score of the six groups.
5. Visuo- and Somatodyspraxia 1.26
This group typically has low scores on Design Copying, Finger Identification, Graphesthesia, Postural Praxis,
Sequencing Praxis, Bilateral Motor Coordination, Standing and Walking Balance, Motor Accuracy, and
Kinesthesia. This group has the lowest Postrotary Nystagmus score of the six groups.
6. High Average Sensory Integration 2.62
This group demonstrates above average functioning in all areas.

Since the comparison feature is not usually very accurate or helpful, we will use the information about “groups” in
a more general sense to understand patterns instead of using this information for specific case interpretation. A
child tested is statistically “like” a group if the D squared value is less than or equal to 1.0.

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 Reading the SIPT Test Report
• Please refer to Appendix 3.1 in the notebook
– Page 1: child’s information and score overview
– Page 2: summary of test scores and visual representation
– Page 3: Standard error of measurement in each test
– Page 4 and 5: Part scores of each test
– Pages 6 and 7: general information about scores
– Page 8: Comparison with cluster groups
– Pages 9 to 14: These pages provide information about
the scores you have entered
– Page 15: Comparison with other cluster groups

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 Interpreting SIPT Results in Practice
• Consider individual test and sub‐tests scores
• Consider the relationship of low test scores to the theory
of sensory integration
• Take into consideration other evaluation data: reason for
referral, parent questionnaires, clinical observations,
outcome measures, other standardized tests
• Use the SIPT data to plan the intervention
• Anticipate how you will measure the outcomes of the
intervention
• Consider alternative forms of evaluating the functions
tested with the SIPT

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 Exercise: Describe
• Please review Appendix 3.3 in the Notebook:
Description of SIPT tests before doing this exercise

• Exercise: Describe alternative measures of the skills

addressed in the SIPT – Appendix 3.4 in Notebook

Assignment: Complete and submit Appendix 3.4 via the Assignments tool. 47