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The Schroeder Block Campbell Evaluation

The adult psychiatric sensory integration


evaluation
Covers sensory & motor responses;
developmental history; & various
neurologic soft signs
Various evaluation procedures normed
for children are used informally by
clinicians for adult clients with brain
damage
Historical development
San Diego Veteran’s Administration Medical Center
15 clients with chronic schizophrenia, paranoid schizophrenia, &
hyperkinetic adult syndrome
Tested both on & off medications
SBC evaluation & 11 subtests from the Southern California
Sensory Integration Tests by Ayres
Rationale:
To have an objective numerical score of a patient’s ability to perform
at any given point in time
When reliability, validity & norms are established, it is possible to
objectively evaluate:
An individual client over time
The effects of medication, or other forms of treatment, both acutely & over
time
Groups of clients by diagnosis or by other criteria
Benefits to the client:
The physician & treatment team have a better understanding of their client’s
physical ability to interact with his environment
The client himself better understands his physical abilities & disabilities
An increased understanding of the neurologic components of psychiatric
Literature review
Focuses primarily on measurable
perceptual & motor changes in
schizophrenia
Many methodological & technical flaws
in the reported results.
Any research on perception is as
complicated as the perceptual response
itself
Literature review - neurochemistry
Neuroregulators are thought to be primarily under genetic
control but responsive to stress. Given enough of a specific
stress, the neurochemical mechanisms are altered,
initiating changes in perception & behavioral responses
which are then labeled to as a psychiatric disorder.
Disordered dopamine transmission in schizophrenia
Lowered MAO platelet activity & a corresponding low
platelet activity in 1st degree relatives
Reported correlation between lowered MAO inhibitors,
platelet activity, increased incidence of abnormal EEG, &
presence of auditory hallucinations
High level of endorphins in schizophrenia
The report or an exciting finding & then difficulty in
replicating the results has plagued schizophrenia research
Literature review – vestibular system
Leach study – schizophrenic groups showed diminished
reactivity, with the greatest deficits occurring under
conditions of weak stimulation, & were relatively more
normal with increased stimulation.
Some studies report transitory hyporeactivity
Some studies, acute & chronic schizophrenic clients
demonstrate normal vestibular responses
Holtzman observed eye tracking dysfunctions in
schizophrenic patients & their relatives.
The vestibular system plays a significant role in perception,
& is intricately interconnected to many brain structures,
some of which are known to be affected by dopamine
More research needs to be done to clarify which subtypes,
in any, of schizophrenic clients show vestibular
involvement.
Literature review – psychomotility
Involves processing information &
responding to stimulation
Psychomotor changes parallel the course
of clinical improvement, & clients
responding favorably to tranquilizing drugs
do significantly better on psychomotor
tests before & after drug administration
Weaver & Brooks – high association
between good or poor psychomotor
performance & release from the hospital;
75% accurate prediction of patient
outcome was made based on psychomotor
Literature review – body image
Almost all reports of body image refer to
figure drawings
Despite problems of validity & reliability,
body image is included because it tells
so much about the quality of the client’s
perception of himself.
Literature review – anatomical changes

Marsden reports cerebral atrophy &


cognitive impairment observed
Johnstone – cerebral ventricular size is
highly significant in relation to cognitive
impairment
Other anatomical changes:
Motor end plate alterations or branching &
sprouting of nerve twigs,
abnormal electromyograms,
Increased electrical activity of skeletal muscles
at rest
Increased incidence of morphological
Literature review – laterality
Gur study – left sidedness on laterality
scores
Flor-Henry – increased EEG foci in the
left temporal lobe of schizophrenics
Other researchers found less eye &
hand congruence in schizophrenics than
normals
Literature review – abnormal movements
Movement disorders in schizophrenia have been reported
before the advent of drugs, & includes stereotypic
mannerisms, hypo & hyperkinesia
Also involuntary ocular movements (deviant eye tracking,
gaze disturbance, altered blink rates, eye deviation,
abnormal saccadic movements & failure to converge)
Can occur from side effects of neuroleptic medication due
to toxicity, hypersensitivity, & long term use
Can be affected by a subject’s anxiety, by interpersonal
contact, & by physical contact with persons
Dyskinesias are involuntary movements & are thought to
occur in older psychotic patients in whom long term
treatment with the anti-psychotic drugs of phenothiazine &
butyrohenone groups has occurred.
Literature review – neurologic soft signs

Soft signs are chronic, & non-life


threatening & can refer to any
neurologic deviation: motor, sensory, or
integrative
Manifestations:
Delay in reaching developmental milestones
Difficulty in acquiring simple athletic skills
Learning problems
Organic indicators on mental status exams
Behaviors assessed
Behaviors assessed
Scoring is based on a 0-3 scale (0 is normal,
1,2,3 are the degrees of divergence from
normal)
It is an evaluation tool consisting of definite
procedures, observations, scoring, work
sheets,& summary sheets
Dominance
Eye, hand & foot dominance
Eye: subject asked to look through a paper tube at an
object on the wall; paper tube is replaced by a piece of
cardboard which has a ¼ inch hole in its center; key ring
Hand: write his name on top of the paper
Foot: asked to hop on 1 foot 3x; kick softly a ball in front of
Behaviors assessed
Posture
Stand in relaxed position; therapist runs the fingers down the spine for lordosis,
kyphosis, scoliosis, asymmetrical posture, inward rotation of the shoulders
Neck rotation
Rotate head first clockwise, then counter-clockwise; smooth or jerky? Full ROM?
Gait
Walk away from the therapist & return; associated arm movements? Shuffling?
Hand observations
Place hands palms down, and then turn palms up to look for abnormal hand
structure
Grip strength
Dynamometer assessment
Fine motor control
Use of tapping board to tap as fast as he can using the index finger of the
dominant & non-dominant hands
Diadochokinesis
Alternately pronates & supinates both hands simultaneously for 10 seconds;
smoothness & synchronization of movement?
Behaviors assessed
Finger-thumb opposition
Touch each finger of one hand to the thumb; smoothness of movement? Speed?
Coordination? Ability to perform without visual cues?
Visual pursuits
Visually track a penlight without moving the head
Bilateral coordination – upper extremity
Draw two circles simultaneously on a blackboard, one with each hand; eye-hand
coordination? Ability to coordinate the motor use of both Ues?
Cross the midline
Draws a line from his left to his right on the blackboard & retraces it; subject
crosses? Avoids crossing? Line irregular?
Stability of the upper extremity
Clasp his hands in front of his chest, therapist places one hand above & one hand
below the subject’s hands, then pushes & pulls; keep hands within 8 inches of his
chest?
Stability of the trunk
Stand & hold his body still, he is then pushed FW, side to side, BW; ability to co-
contract trunk? Steps to avoid losing his balance? Excessive fluidity?
Classical Romberg
Test for balance; walk a line on the floor without looking at the line, then to retrace
Behaviors assessed
Sharpened Romberg
Cross his arms over his chest & place his feet in the tandem walking position,
subject holds this position for 30 seconds with eyes open, 30 seconds with eyes
closed
Overflow movements
Stand with both arms extended at shoulder height with fingers extended & slightly
apart; with eyes closed, he is asked to hold position for 30 seconds; movements
exceed 3 inches?
Neck righting
Same as used to test overflow movements; First rotates subject’s head to the
right, then to the left; trunk & arms tend to align with the head?
Rolling
Subject’s ability to rotate his trunk; roll on a mat to his left, then to his right
Asymmetrical tonic neck reflex
Quadruped position, making sure that his elbows are clearly visible; head turned
to the right, held for 5 seconds, then turned to the left & held for 5 more seconds
Symmetrical tonic neck reflex
Examiner extends subject’s neck & holds it for 5 seconds, then lowers the head
towards the chest & holds it for 5 more seconds
Tonic labyrinthine reflex
Pivot prone position & hold it for 30 seconds
Behaviors assessed
Protective extension
Upsets balance by pushing him to the front & to the sides, & by
pulling him backwards; reaction slow? Adequate? Absent?
Seated equilibrium
Wear a safety belt, to straddle an inflatable, & to rock side to side
without holding on to the inflatable; right his head & trunk when
rocking? Ease to do the task? Balance?
Body image
Draw a complete picture of a person; size of the drawing? Anatomy
indicators?
Abnormal movements
2 types: those that show upon activation & those that show
spontaneously
Automatic obedience – extends the subject’s arm over his head, holding it for
30 seconds
Cogwheel rigidity – flexing the subject’s arm & feeling for intermittent
contraction of either biceps or triceps
Tongue protrusion – protrude his tongue, timing it for 30 seconds
Self-reported childhood history
Developmental history is taken to see if the subject has had any