sensory integration inventory itemi

7/24/2019 Sensory Integration Inventory Itemi

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Sensory Integration Inventory

Tactile: the individuals use of and reactions to the sense of touch

Directions: Mark each category with one of the following

Nif never has the behavior,

O if the behavior happens occasionally and

F if the behavior occurs frequently.

Dressing Issues Social Behaviors___Resistance to layers of clothing ___Looks fearful, angry or uncomfortable

___Pushes up pant legs, sleeves or shirts when touched or approached___Strips off clothing ___ithdraws or hits when eers

___Refuses to undress reach toward them or arenearby

___!requently ad"usts clothing as if it ___ithdraws or hits when staff reach

binds or is uncomfortable toward them or are nearby

___raps self in clothing or bedding ___Rubs spot after being touched___ #nsists on having something wrapped ___$%hibits clingy behavior

around finger, wrist or arm ___&ries to handle or touch everything

___ 'voids or irritated by certain or everyone materials or te%tures ___'voids hand contact with ob"ects

___ #ndicates distress when barefoot or people

___ #nsists on being barefoot

Other !ctivities of Daily "iving #ersonal Sace

$$$ Spits or re"ects certain food te%tures ___ #nsists on large personal space

___Resists grooming (circle which ones) ___ Seeks small spaces to calm ora. washing face e. tooth brushing comfort themselves.

b. combing hair f. nail trimming ___ Prefers to be in a corner, under a

c. cutting hair g. bathing table or behind furniture.d. washing hair h. shaving

Self Sti%ulatory Behaviors Self&In'urious Behaviors

___Persistent hand mouth activity ___Scratches

___*ouths ob"ects or clothing ___Pinches

___Rubs or plays with spit ___Rubs___Persistently has hand in pants or pocket ___+its or slaps

$$$ Sits on hands or feet ___Pulls +air

___Pushes or rubs body against ob"ects, ___ites hand, wrist or arm

walls or people___#nsists on holding an ob"ect in hand

___Rubs finger(s) against hand or other fingers

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#roriocetion: the unconscious ercetion of %ove%ent and satialorientation

Directions: Mark each category with one of the followingNif never has the behavior,



Motor Skills (eneral )eactions

$$$ #s clumsy or awkward in movement ___ ifficulty with transitions between

___oes not position self in middle of activities, places or people

!urniture or equipment ___ /npredictable emotional outbursts

___#s awkward when getting on or off ___ Slow to recover or hard to calmfurniture or equipment when upset

___#s physically rough with people and ___ oes not respond to pain, touch,ob"ects sound, smell or light

___Pinches when attempting to grip ___ *akes repetitious 0vocal1 sounds

___&ouches or holds ob"ects lightly ___istractible, short attention to tasks

___oes not shape hand to hold ob"ects or ___ +ypersensitive to touch, sound,___Looks at hand to reach accurately or smell or light

Perform similar tasks ___elayed response to social

___ /ses 0high stepping1 when ascending communications, light, smell or

or descending steps ___ ifficulty orienting to others or___ +olds ob"ects placed in hand instead of new activity

manipulating it.

Self Sti%ulatory Behaviors Self&In'urious Behaviors

___!laps hands, claps, "umps, hops, stamps ___utts head or body againstto an unusual degree stationary ob"ects

___alks on &oes ___ands head

___Pulls against ob"ects clenched in teeth ___Slaps2hits self___Presses or bands heels or wrists ___ites hands2writs2arms

___3limbs in inappropriate places

___Pushes or leans heavily against people or

!urniture

___4rinds2clenches teeth___ites ob"ects2other

Muscle Tone

___Lacks defined body contours

___&ires easily___Passive unless encouraged to assist in movement

___emonstrates a weak grip

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___Speech is slurred or mumbled

*esti+ular Syste%: detects %otion and generates refle,es that affect eye%ove%ents- osture and +alance

Directions: Mark each category with one of the followingNif never has the behavior,



Muscle Tone Bilateral .oordination

___6eeds assistance when moving from ___/ses mainly one hand at a time

sitting, lying, or standing ___'voids reaching from side to side

___/ses arms to assist self when moving ___&iming uneven in when using both

from sitting, lying, or standing hands or feet___Props head or leans when sitting or standing

___3ollapses onto furniture

Self Sti%ulatory Behaviors /%otional /,ression

___Rocks body ___isplays insecurity in open high

spaces (looking overrailings, or in glass elevators)

___ags head ___&enses or becomes irritable when

___ Rotates or twirls body moved

___aives or flicks fingers near eyes ___ecomes upset at changes in ___Pacesroom arrangements

___alks with a bouncing gait ___Looks an%ious when moving

___+as spurts of running from place to place

/0uili+riu% )esonses Satial #ercetion

___Loses balance easily ___umps into ob"ects

___!alls or trips often ___+as difficulty going through doorways___+olds onto staff, railing, wall ___$%hibits hesitancy on stairs or ramps

___Persistently sits on floor ___escends or ascends stairs or ramps

___+as slow or no response to protect self without alternating feet

#osture and Move%ent

___isplays S curve posture___+olds arm fle%ed, away from body or turned into body

___Shuffles feet when walking

___/ses wide based placement of feet to stand___Swings shoulders side to side while walking

___+olds head and neck in stiff positions

___Resists being moved by others

___'voids or needs assistance to reach things at heights above their head

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___'voids activities that require lots of movement

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sensory integration inventory itemi

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