Sensory Profile Score Sheet

Name:

DOB;

UR:

Raw Scores Low Registration Sensation Seeking Sensory Sensitivity

1 Item No. Score Item No. Score Item No.
2
3 3 0 2 0 7
4 6 0 4 0 9
5 12 0 8 0 13
6 15 0 10 0 16
7 21 0 14 0 20
8 23 0 17 0 22
9 36 0 19 0 25
10 37 0 28 0 27
11 39 0 30 0 31
12 41 0 32 0 33
13 44 0 40 0 34
14 45 0 42 0 48
15 52 0 47 0 51
16 55 0 50 0 54
17 59 0 58 0 60
18 TOTAL: 0 0
19
20
21
22
23
24
25
26 Quadrant Summary (18-64yr)
27
28 Low Registration
29 Sensation Seeking
30 Sensory Sensitivity
31 Sensation Avoiding
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57 Developer: Brock Cook
58 Occupational Therapist
59
60
 Taste Smell Processing Patt
Behavio
Neurological Response
Threshold Regulat

Low High Active

Sensitivity Sensation Avoiding 1 0 0
Score Item No. Score 2 0 0
3 0
0 1 0 4 0 0
0 5 0 5 0 0
0 11 0 6 0
0 18 0 7 0
0 24 0 8 0 0
0 26 0 TOTAL: 0 0 0
0 29 0 0
Normal Threshold Nil
0 35 0
0 38 0
0 43 0 Visual Processing Pattern
0 46 0
Behavio
0 49 0 Neurological Response
0 53 0 Threshold Regulat
0 56 0
0 57 0
0 0 Low High Active
17 0 0
18 0 0
19 0 0
20 0
21 0
22 0
23 0
Much Less Less Than Similar to More Than Much More 24 0 0
Than Most Most Most Most Than Most 25 0
15-18 19-23 24-35 36-44 45-75 26 0 0
15-35 36-42 43-56 57-62 63-75 TOTAL: 0 0 0
15-18 19-25 26-41 42-48 49-75 0
Normal Threshold Nil
15-19 20-26 27-41 42-49 50-75

Activity Level Processing Pat

Behavio
Neurological Response
Threshold Regulat

Low High Active

40 0 0
41 0
42 0 0
43 0 0
44 0
 45 0
46 0 0
47 0 0
48 0
49 0 0
TOTAL: 0 0 0
0
Normal Threshold Nil
attern Movement Processing Pattern
vioral Behavioral
nse/ Self Neurological Response/ Self
lation Threshold Regulation

Passive Low High Active Passive

9 0 0
10 0 0
0 11 0 0
12 0 0
13 0 0
0 14 0 0
0 15 0 0
16 0 0
0 TOTAL: 0 0 0 0
0 0 0
Nil Normal Threshold Nil

ern Touch Processing Pattern

vioral Behavioral
nse/ Self Neurological Response/ Self
lation Threshold Regulation

Passive Low High Active Passive

27 0 0
28 0 0
29 0 0
0 30 0 0
0 31 0 0
0 32 0 0
0 33 0 0
34 0 0
0 35 0 0
36 0 0
0 37 0 0
0 38 0 0
Nil
39 0 0
TOTAL: 0 0 0 0
0 0
Normal Threshold Nil

Pattern Auditory Processing Pattern

vioral Behavioral
nse/ Self Neurological Response/ Self
lation Threshold Regulation

Passive Low High Active Passive

50 0 0
0 51 0 0
52 0 0
53 0 0
0 54 0 0
 0 55 0 0
56 0 0
57 0 0
0 58 0 0
59 0 0
0 60 0 0
0 TOTAL: 0 0 0 0
Nil
0 0
Normal Threshold Nil

x
 OCCUPATIONAL THERAPY SENSORY REPORT

NAME:
DATE OF BIRTH:
UR NUMBER:
REFERRED BY:

THE SENSORY PROFILE

The aim of the sensory profile is to better understand how a person processes their sensory information
and how this contributes to their functioning in an environment/ situation. The results are then scored
into 4 quadrants named low registration, sensation seeking, sensory sensitivity and sensation avoiding.

1) Low registration is where people have a low responsivity to responding to sensory information and
usually need higher levels of stimulus to notice.

2) Sensation seeking has low responsivity to situations but an active threshold “oooh I like it. Keep it
going”

3) Sensation Sensitivity is where people have a high responsibility but a passive threshold “this
me”

4) Sensation Avoiding has a high responsivity but an active threshold “argh… I have to get away”

Sensory modulation dysfunction is where a mis-match is found between the external contextual
demands of a person’s world (culture, tasks, environment and relationships) and their internal
characteristics (attention, emotion, sensory processing). Difficulties with sensory modulation result in
the following:-
 Over- responsivity
 Under-responsivity
 Fluctuating responsivity

Functionally this can affect behaviour through:-

 Lower arousal makes us feel lethargy, drowsiness, boredom and ‘flatness”
 Adequate arousal makes us feel that successful participation is possible
 Higher arousal leads to distractibility, hyperactivity and anxiety/ fear.
<Client Name>’s sensory profile scores are as follows:

Quadrant Raw Score Interpretation % comparison to population

Low Registration 0 /75 No Data No Data
Sensation Seeking 0 /75 No Data No Data
Sensory Sensitivity 0 /75 No Data No Data
Sensation Avoiding 0 /75 No Data No Data
 A Sensory Profile was administered to <Client Name> <Reason for Profile being Completed>
recommendations drawn from that sensory profile are outlined as follows:

Sensory Profile
These results indicate that <Client Name> is finding it difficult to modulate sensory responses. In
RECOMMENDATIONS:
 INSTRUCTIONS
<==Report Low Registration High Scores
<==Report
<==Report
<==Report
<==Report
<==Report
<==Report
<==Report Taste/smell Movement Visual Touc h Activity Level
<==Report Low Make meals Use larger, more Make visual cues, Use visual cues Go to meeting
<==Report Registration more forceful movements underline, bold, to notice when prepared with
<==Report interesting, before refining highlight, use things are questions ready
<Client incorporate patterns colour touching you
Name> unfamiliar Ask people to
scored “More foods, Use weights or other Label drawers, Ask others to let summarize/
than most unusual form of resistance cabinets you know if you restate the most
people” combinations, are getting to important points
or foods with Use visual cues Take notes so close
intense tastes (watch where you that information Use lists
or smells are going) ro support can be reviewed Set water reminders, date
<==Report movement activities and processed heaters at a books, calendars
<==Report Use extra later lower
<==Report care when Use/add stair rails, temperature to Shop in stores
drinking hot bars, and other cues Use mirrors to prevent burns with clearly
<==Report liquids to mark steps, check personal marked areas or
<==Report doorways, etc. appearance Pay attention to helpful workers
<==Report Make sure weather reports
<==Report smoke Put anti skid Place important to determine Talk yourself
detectors are bathmats in objects (keys, bills appropriate through a task to
<==Report present and bathroom to be paid) in dress make sure you
<==Report working obvious location are aware of the
<==Report Wear non skid shoes Add texture to steps
<==Report Change colours, objects to help
Make sure pathways fonts, to decrease with detection Write something
<==Report
are clear of objects familiarity/ (eg. Use puffy down or talk it
<==Report Low Registration Low Scores
<==Report
<==Report
<==Report
<==Report
<==Report

Taste/smell Movement Visual Touch Activity Level

Low Select Foods Select exercise Choose neutral Use soft, smooth, Maintain
Registration with mild or activities that colours non-textured consistent steps
bland flavors incorporate products, clothing routines, in daily
repetition (eg. Arrange objects activities
Use non- Walking, in simple Wear loose-fitting
<==Report <Client scented swimming) patterns; use clothes Seek familiarity in
<==Report Name> products, or symmetry settings, people,
scored “Less select Sit in a rocking Keep experiences
<==Report than most comforting, chair temperatures at a
<==Report people” low intensity consistent,
<==Report smells comfortable
<==Report setting
<==Report
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<==Report
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<==Report Sensation Seeking High Scores
<==Report
<==Report
<==Report
<==Report
<==Report
<==Report
Taste/smell Movement Visual Touch Activity Level
Sensation Chew gum or Incorporate Select bright Choose Look for group
Seeking eat mints movement into colours and/or activities that activities
when feeling activities dramatic shapes incorporate
<Client restless physical contact Find
Name> Engage in a physical Use bright lighting (dancing, ball opportunities for
scored “More Use scented activity before a games) or with self expression
<==Report than most soaps, thinking task Look for the environment
<==Report people” shampoo’s environments with (Gardening, Incorporate
<==Report and Select physical lots of visual cooking, novelty into your
conditioners activities that interest and relaxation, daily routine
<==Report
incorporate bending activity sports)
<==Report Wear scented over, throwing balls Go about tasks
<==Report deodorant, and changing In meetings, Select clothes, (drying your hair,
<==Report perfume, speeds/directions classes, offices, utensils and washing your
<==Report cologne or etc. find places to creative face/hands) in a
body sprays sit where you can activities that new way
<==Report
easily change provide
<==Report Make spices, your visual
<==Report hot sauces perspective Go barefoot
<==Report available for
<==Report meals Use varying
textures of
<==Report
Eat foods you carpets, towels
<==Report
<==Report
<==Report Sensation Seeking Low Scores
<==Report
<==Report
<==Report
<==Report
<==Report
<==Report
Taste/smell Movement Visual Touch Activity Level
Sensation Explore new Pursue a new Consider trying Go for a massage Spend time in
Seeking foods, ask physical activitiy new colours in the natural
friends to (e.g. join a your wardrobe, Incorporate texture in environment
introduce you bowling league, living space or clothing and objects (e.g. parks,
<Client to restaurants take Aerobics or work place lakes, hiking
Name> or foods dance class) Tak e awarm bath trails.)
<==Report scored “Less you’ve never Visit a museum and use a bath mitt,
than most tried Change the order loofah sponge, or Cook
<==Report people” or the way you go Rearrange your textured washcloth something from
<==Report Try scented about your furniture scratch
<==Report products (e.g., morning self-care
<==Report lotions, routine Vary the order
soaps) in which you go
<==Report
Attend to how about your daily
<==Report Light scented your body feels routine
<==Report candles when you are
<==Report moving. Take
<==Report
<==Report
<==Report
<==Report
<==Report
<==Report
<==Report
<==Report
<==Report These recommendations can be used by both <Client Name> and clinicians working with <Clie
<==Report to help him in being able to comply and benefit from any treatment or intervention that he might
<==Report of. <Client Name> can also use these simple techniques in his everyday life to aide him in his
<==Report functioning.
<==Report
<==Report
<==Report Please call the number below if you have any queries in regards to this report.
<==Report
<==Report
<==Report
<==Report
<==Report
<==Report
<==Report
<==Report
Brock Cook
<==Report
Occupational Therapist
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 Sensory Sensitivity High Scores

Taste/smell Movement Visual Touch Activity Level

S ensory Find Use a rocking Use systematic Use deep- Incorporate breaks and
S ensitivity Scented chair for calming methods of pressure touch time-outs
products that effects visual scanning rather than light
<Client you like and (e.g. reading) touch Look for smaller, less
Name> use them Limit the amount crowded, more
scored regularly of steps when Cover or Wear cloths organized stores in
“More than learning a new visually block that are heavy which to do your
most people” Identify movement activity out information or weighted shopping
flavours and
ingredients Select movement Organize Wrap yourself Use self-cues to stay
that you activities that drawers and in a blanket focused – talk aloud or
prefer, and allow you to keep closets so that to yourself when
always find your head upright it is easy to pick Use lots of executing a task
ways to and/or maintain a out what you blankets or
incorporate constant speed are looking for. heavy Break tasks down into
them into (e.g. bike riding) comforters on smaller bits
daily meals Eliminate the bed
background Put materials into
Introduce visual stimuli – sequential order
new foods place objects
and smells so that they are Write out steps to a task
gradually in one layer and check them off as
you complete each one

Make a plan before

starting a task

Identify the steps and

Sensory Sensitivity Low Scores

Taste/smell Movement V isual Touch A ctivity Level

S ensory Add herbs, Ask a partner to Add colour and Wear clothing that Make a conscious
S ensitivity spices, etc, to help you figure variation to moves or has effort to attend to
foods, and try to out new written different textures sensory features of
distinguish the movement information daily life
<Client tastes when patterns Use light touch
Name> eating them Make instead of deep Change where you
scored “Less Participate in presentations pressure usually sit in
than most Visit places that activities that of visual meetings, classes, or
people” have various incorporate information mealtimes, in order
smells (eg. different kinds variable and to get a different
Candle stores, of movement unpredictable perspective
flower shops) (eg. Aerobics,
 Sensation Avoiding High Scores

Taste/smell Movement Visual Touch Activity Level

S ensation Ask for Elevators, Periodically close Explain your Avoid traffic-
Avoiding sauces and escalators, and high your eyes to need for congested areas,
dressings on places may be decrease visual personal crowds, busy
<Client the side uncomfortable stimulation distance, to times
Name> others
scored “More Use When reasonable, Wear sunglasses Maintain
than most unscented use the stairs When consistency, try
people” cleaners, Use dim or natural purchasing to reduce
soaps, etc When involved in lighting, or even clothing, select disruptions
physical activities, the dark fabrics that don’t
When eating make arrangements irritate, and Establish
out, request to take a break – sit Get rid of clutter styles that are routines that are
that you be down as needed not constricting comforting and
able to supportive
choose the Incorporate routine Position
restaurant and repetition in fans/vents so Find quiet places
movement activities that they are not for time alone
blowing directly
Place the most at you Give yourself
frequesnt used permission to be
objects at arm level Wear gloves alone
in cabinents to avoid when cooking,
having to bend over. gardening etc. Limit large-group

Sensation Avoiding Low Scores

Taste/smell Movement V isual Touch A ctivity Level

S ensation Review your Take breaks or Find or create a Guard against Try meditation
Avoiding diet to see rest during space with limited overexposure to heat ot other
whether you movement visual input and cold relaxation
are including activities strategies
too many Reduce light, ear Ask others to tell you
<Client problematic Consider your sunglasses, etc. if you are invading During
Name> foods movement their personal space activities, take
scored “Less activities and breaks to allow
than most Check with whether you time for
people” those whom pursue them processing
you live/work safely; modify
to see activities if needed Spend time
whether the planning, in