2.1 A Practical Introduction to the Motor Observations

While our test Manual was in research form, it was used yearly for 20 years by over 900 post graduate students studying Sensory Integration Theory, Diagnostics and Treatment given by the Netherlands Center of Sensory Integration. We have now completed various statistical analyzes and have found 36 items (out of 71 original ones) which are reliable and valid. Our U.S. sample was statistically similar to the Dutch sample so it could be analyzed together. If you are from other countries, we, of course, suggest that you consider a pilot study to evaluate if your sample's figures can be used with ours. We would definitely be interested in hearing about your results.

Which children can be given the Motor Observations?

We developed the Motor Observations so that children with various diagnoses could be given the test: ADHD, ADD, autistic spectrum- higher level children, developmentally delayed children, children with speech and language disorders, and those with cerebral palsy. The degree to which each of these children can participate may be limited. Even if the child can only participate in a limited number of items, this provides helpful information to the therapist. The child's scores can serve as the child's own reference.

The verbal directions and demonstrations can be modified for special situations without effecting the statistics. See: Tips on how to read each page of the Motor Observation Manual below.

Theoretical Groups:

Children who can complete the 36 items of the Motor Observations will have their scores analyzed based on Sensory Integration and motor developments theory placed in the following groupings:

  • Stability/Tone
  • Equilibrium and Gravity Responses
  • Rotation
  • Slow Movements
  • Motor Planning


The age range for the test is 5 years 0 months to 11 years 11 months old. The data showed that the children from 8 years 0 months to 11 years 11 months did not differ in their scores so these ages were combined.

Our statistical analysis was based on the following:

  1. 5 years 0 months to 5 years 11 months
  2. 6 years 0 months to 6 years 11 months
  3. 7 years 0 months to 7 years 11 months
  4. 8 years 0 months to 11 years 11 months

Children older than 11 years 11 months may be given the Motor Observations. I have used it for adolescence and adult patients without using the statistics. I have found this useful as well.

Time needed for the Motor Observations:

The time will be approximately 30-45 minutes.

Training needed for the Motor Observations:

This Video and Manual with accompanying information and statistics should be very helpful to student therapists and therapists who have little formal training in this area. We have included a great deal of details to make this a test that can be learned in this fashion. We expect therapists learning the test to practice it on many 'normal' children and possibly adults to feel competent before testing children who need evaluation. A minimum of 5 children for practice had been required for 20 years for the students at the Netherlands Center for Sensory Integration. Practicing on 15 children would be even better.

If you have had training using the clinical observations, almost all the items will be familiar to you. A few items may have slightly different procedures. Having statistics available for the items now is the major reason to use the Motor Observations. A basic understanding of the normal distribution curve and standard deviation statistics is helpful to fully take advantage of the statistics provided. We would like therapists to take appropriate courses if possible, to supplement the Motor Observations, Sensory Integration theory and practice. We plan to provide courses to supplement the Motor Observations in the near future.


When you test children with the Motor Observations we assume that you will use the exact procedures and words as closely as possible to promote the reliability of the data. Because some children need extra help a listing of 'helper procedures' has been developed. Using these helper procedures will help you give the child the Motor Observations without jeopardizing the reliability of the test.

We also use encouraging words through out the Motor Observations, such as "good job", "fine", "good going", But in our Video, there are fewer positive comments than in a usual Motor Observation. This is due to "dubbing" the English Video, which is a rather artificial situation. So in your testing with the Motor Observations, feel free to use positive words and gestures as praise. Keep to the guidelines about adding extra information for the testing.


As mentioned previously, many courses are available for general Sensory Integration Theory, Sensory Processing, Motor and Language Development. Dr. Ayres evaluated several of her clinical observations in her research, linking several items with various dysfunctions. This and newer findings are often reported in courses and articles.

Understanding basic motor development is crucial for understanding why a child cannot accomplish tasks appropriately for his or her age. Take the example: a child cannot put on his or her socks and shoes.

A therapist can analyze this by watching how the child attempts it, and we recommend basic task analysis. Much information can be gleaned by observing the child's motor behavior before and after the task, even though it is not scored. A frequent and obvious problem that effects putting on shoes and socks is that the child does not have adequate sitting balance. What is the cause? Or when children cannot sit in a crossed-leg fashion, the child will have poor sitting balance which effects all activities, including attention. What is the underlying cause? As compensation, a child will hold or prop themselves up with one hand and have only the other hand available for the tasks. But the same basic question is "What is a cause of poor sitting balance?"

Perhaps the child's performance on the Asymmetrical Tonic Neck Reaction and the Dynamic Asymmetrical Tonic Neck Reaction in each direction was poor. Thus, the therapist might say that head and neck movements still unfortunately effect this child's trunk and sitting balance, to some degree. Muscle tone will be evaluated and obviously will have a major effect on sitting balance.

After basic sitting balance, eye-hand coordination is needed to accomplish putting on shoes and socks. A stable trunk and neck is needed so that the child can focus their eyes on their hands and feet when first learning to put on their socks. Good tone in the hands and feet is needed so the child can hold or move them when appropriate. Tactile defensiveness issues may effect the use of the hands and fingers.

After several months of therapy, the child can be re-tested. The problems with Activities of Daily Living are frequently improved with therapy; the Motor Observations re-test can explain why.

If you feel you are not strong in your knowledge of basic motor development, the Motor Observations, with their very structured scoring, can be very helpful in analyzing development. Of course, testing many children in all age groups will be beneficial and as well as observing children in all normal situations. This is one of the best ways to learn.

Materials needed for the Motor Observation Test:

  • You will need a room with a flat floor for a minimum surface area of +/- 15 to 18 feet or 6 meters by +/- 10 feet or 3 meters.
  • You will need firm, anti-slip mats. Usually 2 mats (minimal, +/- 4" by 6" or +/- 1.2 m x 1.8 m.).
  • On the flat floor, uncarpeted floor you will need a straight line readily visible, 10 feet or approximately 3 meters, 1.5 inches to 2.5 inches (3.5 cm to 6 cm). If you do not think the line is visible enough, use masking tape.
  • A pencil with a small toy on top, no larger than 1" - 2" inches or 5 cm. in diameter. The toy must have eyes, or have these clearly drawn on it. It can have no moving parts, such as feathers or springs, and make no noise.
  • A stop watch
  • Stand-up mirror or one that can be propped up against a wall or a built in mirror,
  • Large therapy ball (Bobath ball), no smaller than 22 inches or 65 cm for younger children, and 80 to 100 cm for larger children,
  • One small kindergarten-size ball, approximately 8 inches or 17 cm. in diameter.
  • A vertical , flat wall for the items using paper or a chalk board.
  • Blank paper cut to size(+/- 24 x 17 inches or 30 cm by 25 cm) and pre-dotted. Use masking tape for attaching these prior to testing.
  • 4 thick markers with at least 2 colors, (two are extra) or two pieces of chalk, two colors.

Tips on How to Read each Page of the Manual:

Each page starts with the number and title of the item.

Directly under it is the Extra help/ instructions: seven short phrases which tell you how you can give a child extra help without losing the statistical value of the item.

  1. 1.Extra verbal explanation possible
  2. 2.Limited extra verbal instruction and limited tactile clue
  3. 3.Required demonstration
  4. 4.Extra demonstration possible
  5. 5.Required trial of item
  6. 6.Place child in position if necessary
  7. 7.No extra's (this means no verbal or extra demonstrations are allowable).

Stay within these guidelines.

Requirements and Starting Position:

This tells you what you need for the item and the correct the position to begin the item. For example, in the items requiring the child to sit on the mat, the evaluator sits directly across from the child, at approximately the same height. (Children who cannot sit adequately or comfortably in a crossed legged position may be tested sitting on a small stool/chair, preferably without a back.The evaluator is seated on the same size stool/chair).

Children with Glasses:

The ocular motor items will need to be tested twice: once with glasses off, and the second time with glasses on. The score is the one with glasses off. You may see discrepancies in these scores which are important observations to note. If the child shows any resistance to taking off his or her glasses, note this and test only with his or her glasses on.


Gives you a fairly exact instructions how to perform an item. If exact words need to be said they will be in quotes ("..."). If no words are quoted, this means you can use your own words.


These are as exact as possible. They will demonstrate a procedure or show a correct response.


These are the areas that the scoring is based upon, in most cases.

Administration and Scoring:

Memorize the text, if at all possible. This will be a great help when you have a demanding child to test. If not, use your Manual to read the exact words (underlining the instructions in a high-lighter color is helpful, or read the instructions off of cards you have made).

Each item has its own precise scoring. Please learn this and/or consult your Manual for our scoring criteria. Attempt to be as consequent as possible in your scoring.

As precise as we have tried to be in describing the scoring of the motor items , there are always children who respond in a different fashion, which does not exactly fit the precise scoring descriptions we have provided. When this happens, you should then use the following criteria. This is a general analysis of our scoring method which will give you a reasonable score. (Most items were specifically delineated on a five point scale, based on the Freides' Clinical Observations (1980). Although most items were totally different from each other, the scoring followed basic criteria.


this is the best score and fulfills all the criteria.
the performance is not quite perfect, with a small difficulty.
there are clear problems with performance.
the child attempts the item but performance is very poor.
the child cannot do the item.

Use these criteria when the child does not meet the scoring criteria provided for that particular item. This will not happen frequently but when it does, it allows you to score the item and thus be able to have a complete test.

Score sheets:

Use your score sheets which you have down-loaded from this website. Try to develop a photographic memory. Usually it is best to grade each item as you do it. If you think a child's performance is between scores you can use an arrow to indicate the direction it tends to fall towards. Keep this to a very minimum amount. Naturally, this item cannot be used for statistics.

Video training:

The video we have provided for training is very exact. We think you will profit from it greatly. There are items that will need to be graded based on your own performance with the child. For example, in the item 'Co-contraction-arms', you will need to give slight pressure to the child's arms in a forward, backward and diagonal fashion. The amount of pressure is very slight. The video will be helpful in showing you this, but it is of course your test item. Be as consequent as possible, practice applying the same amount of pressure. In this way you will learn to judge the responses based on your consequent performance.

Tone evaluation:

The item on tone has been a difficult one to scientifically evaluate and therefore it was not included in the Motor Observations. We know that therapists will want to use this information. Since each therapist has learned how to "feel" tone, we advise you to also practice being consequent in your evaluation techniques so that you can make the best judgment possible based on your experience.

From raw scores to printed pages:

When you have finished the full Motor Observations you transfer your scores from your score sheets to the grid you will call up from the beginning of the site. Press either "Add a new test" or in Dutch "Voeg een nieuwe test toe". Enter your patient's information and the raw scores for all the 36 items. Then press "Calculate" or "Bereken". In a few seconds, the next screens will have your data calculated in standard deviatons in color. These can be printed out. The raw scores will be processed by the computer, which will print out the child's results in standard deviations for each individual item, for the theoretical groups, and one for the full Motor Observations.