Two new assessments of sensory integration and processing skills: The SOSI-M and the COP-R

By: Gustavo Reinoso, Ph.D., OTR/L Dominique Kiefer-Blanche, OTD, OTR/L Erna I. Blanche, Ph.D., OTR/L, FAOTA 

As our understanding of sensory integration and the processing construct evolves, so should our measures and assessments. Occupational therapists working with children who present deficits in sensory integration and processing use an array of measures in clinical practice, such as standardized testing, proxy questionnaires, family interviews, biographical accounts, and self-report measures. The information provided by these measures assist practitioners in composing a clinical profile, formulate hypotheses, and develop a plan of care relevant to these children’s lives and their families. The results from these measures are often combined with the use of clinical observations. The primary purpose of clinical observations is to allow the therapist to use clinical judgment to analyze a child’s performance in relationship to sensory processing as informed by evolving theory and research (Blanche & Reinoso, 2008).

For many years, occupational therapy practitioners utilized an unpublished version of Dr. Ayres clinical observations to assist with assessing children. However, determining reference values to support interventions was difficult, as none existed. Thus, different clinical observations were often utilized in clinical settings to provide cut off scores. For example, Gregory-Flock & Yerxa (1984) provided information on prone extension and its relationship to vestibular processing, including some reference values. In 2002, Erna Blanche produced a video and manual providing a unified concept on the administration, interpretation, and clinical reasoning for occupational therapists to use when assessing children with sensory integration and processing challenges. The research available at that time was presented and a model of clinical reasoning for their interpretation was articulated.

Several clinicians were trained in the administration of a research protocol created by Blanche during professional congresses, conferences, trainings, and continuing education opportunities in the US, Asia, Europe, Latin America, and the Caribbean. Practitioners learned the interest and utilization of clinical observations, as well as the administration of unified protocol, when assessing children, which allowed the application of these processes to continue to grow among pediatric occupational therapists. Some countries, like Chile, through their Sensory Integration organizations piloted protocols following the original video protocol (Imperatore-Blanche et al., 2016; Calderon, 2020). An international training was introduced during the last World Federation of Occupational Therapists (WFOT) in South Africa where many clinicians continued to express interest in a unified protocol with standardized procedures and a scoring system. Similarly, the COP which was first published in 2012 revealed strong evidence of construct and discriminant validity among children with autism spectrum disorders (ASD), developmental delays (DD), and typical children (Blanche et al., 2012a; Blanche et al. 2012b). Additional publications, pilot testing studies, presentations, and work have occurred since and have contributed to several revisions in preparation for US based studies. After several developments and pilot studies, two new assessments are now published and available for clinicians with an interest in assessing and treating children with sensory integration and processing challenges. A brief introduction of these two new assessments, i.e. the Structured Observations of Sensory Integration - Motor (SOSI-M) and the Comprehensive Observation of Proprioception – Revised (COP-R), are provided to familiarize those interested (Blanche, Reinoso, & Blanche Kiefer, 2021).

The SOSI-M is composed of 14 individually administered clinical observations and contains several new features, like all materials needed for administration and easy instructions that can be administered in English or Spanish. The 14 clinical observations include: (1) Romberg, (2) Heel to toe, (3) Standing on one foot, (4) Modified Schilder’s Arm extension test, (5) Skipping, (6-7) Series of Jumps, (8) High kneeling, (9) Antigravity extension, (10) Antigravity flexion, (11) Ocular movements (12) sequential finger touching, (13) Diadochokinesis, (14) Projected Actions in Time and Space. These observations can be scored individually or as a group. Additionally, their contribution to different constructs, such as vestibular and proprioceptive processing, postural control, and motor planning, can be easily established. Both manual and electronic scorings are available; the latter offers the ability to generate a comprehensive report detailing all scores and statistics at a very low cost.

The COP-R offers 18 items that are clearly defined and can be observed in both community and clinical settings, as well as during the administration of the SOSI-M. Grouped on sub-scales, clinicians are able to derive differential scores in four areas impacted by proprioception, i.e. tone and joint alignment, postural tone, motor planning, and behavioral manifestations. This measure complements the information provided by the SOSI-M and allows clinicians to refine the impact of proprioceptive deficits on function and participation in daily activities and occupations. Table 1 (page 25) offers a brief summary of some of the main features of both assessment instruments. Additional details can be found in the publication manual.


Together, the SOSI-M and COP-R offer a robust, novel way of assessing sensory integration and processing, which will assist clinicians in developing new databased evidence, plans of care, and interventions. The strong psychometric properties of both instruments offer clinicians and researchers the possibility of collaborating on small and large-scale studies aimed at elucidating the sensory integration and processing contributions to participation in children and adolescents in valued and meaningful occupations.



Blanche, E. I. and Reinoso, G. (2008). The use of clinical observations to evaluate proprioceptive and vestibular functions. OT Practice, 13(17). American Occupational Therapy Association (AOTA).

Blanche, E. I., Bodison, S., Chang, M. C., & Reinoso, G. (2012a). Development of the comprehensive observations of proprioception (COP): Validity, reliability, and factor analysis. American Journal of Occupational Therapy, 66(6), 691-698. ajot.2012.003608

Blanche, E. I., Reinoso, G., Chang, M. C., & Bodison, S. (2012b). Proprioceptive processing difficulties among children with autism spectrum disorders and developmental disabilities. American Journal of Occupational Therapy, 66(5), 621-624. https://doi. org/10.5014/ajot.2012.004234

Blanche, E. I., Reinoso, G., Blanche Kiefer, D. (2021). Structured Observations of Sensory IntegrationMotor (SOSI-M) & Comprehensive Observations of Proprioception (COP-R). Administration Manual. Academic Therapy Publications (ATP).

Blanche, E. I., Pediatric Therapy Network., & Western Psychological Services (Firm).

(2002).Observations based on sensory integration theory. Los Angeles, CA: Pediatric Therapy Network, Western Psychological Services.

Calderon, E. D. (2020). Resultados de un modelo de entrenamiento de las observaciones clínicas estructuradas en el aprendizaje de su administración y de los criterios de calificación. Revista Chilena de Terapia Ocupacional, 20, 133-144.

Gregory-Flock, J. L., & Yerxa, E. J. (1984). Standardization of the prone extension postural test on children ages 4 through 8. American Journal of Occupational Therapy, 38, 187–194.

Imperatore Blanche, E., Reinoso, G., Blanche-Kiefer, D., & Barros, A. (2016). Desempeño de niños típicos entre 5 y 7.11 años de edad en una selección de observaciones clínicas: Datos preliminares y propiedades psicométricas en una muestra Chilena. Revista Chilena de Terapia Ocupacional, 16(1) 17-26

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