Occupational Therapy:-

What Is Occupational Therapy?

What is the role of Occupational Therapy in Pediatrics?

Reasons You Might Refer a Child for Occupational Therapy ?

What can OT offer my child?

What areas does OT address?

Occupational therapists can help children:

Assessment Strategies and Tools

• Performance Components
• Performance Areas
• Non standardized Assessment/Clinical Observation

Service Models

• Direct service to the child and family
• Consultation to the family or other team members such as the classroom teacher
• Monitoring of performance and progress

Intervention Strategies

What Is Occupational Therapy?

                                        Occupational therapy is the therapeutic use of self-care, work and play activities to increase independent function, enhance development and prevent disability. Since the work of children is play, it is through the use of this media that occupational therapists assist children in learning the skills necessary for living. Concerns often addressed by pediatric occupational therapists include self-care skills (feeding, bathing, dressing), fine motor skills (hand skills and dexterity), Neuro motor development, sensory integration, and play skills. Therapy can enhance the potential of a child throughout their developmental years and build skills, self-confidence, and self-esteem that lasts a lifetime.

What is the role of Occupational Therapy in Pediatrics?

Occupational therapists working with children strive to optimize a child’s occupational performance. Children span the age range of birth through adolescence. Just think what a variety of occupations you were engaged in during this period of time in your life. Consider how these occupations become increasingly complex during childhood and how they formed an important foundation for the roles you play as an adult today. The primary occupations of children are considered to be:

• Activities of Daily Living     (feeding,toileting,dressing,grooming,mobility)
• Learning and school performance
• Vocation or performance in a workplace

A core value of pediatric occupational therapy is providing family-centered care and service. The needs, desires, and values of the child and family drive the direction of our assessments and intervention. The focus of occupational therapy intervention directly reflects the child’s and/or family’s priorities.

To further appreciate the role of occupational therapy in pediatrics let’s explore the:

• Assessment process and tools used to evaluation children’s capacity for occupational
• performance
• Types of service models for intervention
• Interventions an occupational therapist uses
• Practice settings

Reasons You Might Refer a Child for Occupational Therapy

• Poor sensory regulation and organization
• Delayed gross and/or fine motor skills
• Poor pre-writing and handwriting skills
• Difficulty with motor planning and sequencing activities
• Delayed or limited repertoire of play skills
• Poor oral-motor control for feeding (sucking, chewing, swallowing)
• Delayed or limited self-care skills (i.e., managing clothing fastenings, self-feeding,        
• preparing a simple snack, managing money)
• Limited social skills or behavioral-adaptive skills (i.e., coping skills, establishing
•  friendships, cooperative play with peers)

What can OT offer my child?

• Developmental screening/testing
• Visual motor testing
• Therapeutic listening
• Oral motor stretching
• Visual perceptual testing
• Sensory integration services
• Oral motor strengthening

What areas does OT address?

• Developmental Delays
• Attention and focus
• Writing problems
• Self dressing/grooming (Activities of Daily Living)
• Strengthening – general and specific
• Gross motor concerns
• Coordination difficulties
• Sensory motor processing
• Perceptual difficulties
• Oral motor weakness
• Fine motor concerns

Occupational therapists can help children:

• Decrease developmental delays.
• Improve writing and drawing skills.
• Improve oral-motor strength.
• Decrease oral-motor (structural) tightness.
• Improve overall strength.
• Improve overall coordination.
• Improve visual perceptual skills.
• Improve grasp and fine motor skills.
• Improve self-dressing, feeding, and grooming skills.
• Assist with increasing overall internal organization, focus, and attention.
• Improve sensory motor processing abilities.
• Desensitize children to their difficulties and instill confidence, trust, and self-esteem!

Assessment Strategies and Tools

Occupational performance is influenced by the dynamic relationship of person, occupation and environment. At First Step Rehabilitation Centre occupational therapist must consider all aspects of this relationship when performing an assessment.
The occupational therapist assesses and considers factors within the child, the environment, and occupation to determine what changes or adaptations are needed in any of these arenas to improve the desired occupational performance and success.

Occupational Therapy Practice: Assessment

Assessment Tools
The following is a list of assessment tools typically administered by the occupational therapists in the First Step Rehabilitation Centre. This is not an exhaustive list of tools available, rather it is a sampling of the more commonly used pediatric assessment tools.

• Performance Components
• Performance Areas
• Non standardized Assessment/Clinical Observation

Performance Components

Peabody Developmental Motor Scales (Folio & Fewell, 1983)

• Age range: Birth - 7 years
• Evaluates gross and fine motor skill development
• Yields standard score, percentile rank, and age equivalency for gross motor and fine motor performance

Bruininks-Oseretsky Test of Motor Proficiency (Bruininks, 1978)

• Age range: 4 1/2 - 14 1/2 years
• Evaluates the proficiency of gross and fine motor skill performance
• Yields standard gross motor composite, fine motor composite, and total battery composite score as well as percentile rank in each area

Developmental Test of Visual Motor Integration (Berry, 1996) - VMI

• Age range: 2 - 15 years
• Evaluates the integration of visual motor and visual perceptual skills for purpose of early identification of learning difficulties
• Yields standard scores, percentile rank, and age equivalency scores

Motor Free Visual Perceptual Test - Revised (Colarusso, Hammill, Mercier)

• Age range: 4 - 11 years
• Screens visual perceptual skills by requiring the child to indicate her response using only pointing; assesses the areas of spatial relationships, visual discrimination, figure-ground, visual closure, and visual memory
• Yields a standard perceptual quotient and perceptual age equivalency

Developmental Test of Visual Perception - 2nd Edition (Hammill, Pearson, Voress, 1993)

• Age range: 4 - 10 years
• Evaluates visual perceptual skills using both motor and non-motor responses; assesses the areas of eye-hand coordination, position in space, copying, figure-ground, spatial relations, visual closure, visual-motor speed, and form constancy
•            Yields standard composite scores for general visual perception, motor-reduced visual perception, and visual-motor integration

Performance Areas

Pediatric Evaluation of Disability Inventory (Haley, Coster, Ludlow, Haltiwanger, Andrellos, 1994) - PEDI

• Age range: 1 month - 7 years
• Evaluates the child's functional skill ability and degree of caregiver assitance in three domains: self-care, mobility, and social function
• Yields a normative standardized score in each domain; totals for frequency task modification and caregiver assistance may be calculated

School Function Assessment (Coster, Deeney, Haltiwanger, Haley, 1997) - SFA

• Age range: kindergarten - 6th grade
• Evaluates functional performance in the elementary school setting which includes: participation in school activity settings, amount of assistance and adaptation for task performance, and performance in nine physical task areas and twelve cognitive/behavioral task areas
• Yields a standard score in each of the areas assessed and cut scores identify the typical range of performance for non-disabled children

Sensory Profile (Dunn, 1999)

• Age range: recommended for 5 - 10 years (may be used for children 3 - 4 years)
• A caregiver questionnaire designed to help the occupational therapist gain understanding of a child's sensory processing during daily routines (i.e., hyper-responsive or hypo-responsive to certain sensory events). This includes how the child tends to respond to stimuli and which sensory systems may be creating barriers to functional performance.
• Yields a descriptive profile of a child's sensory processing and sensory modulation abilities. Cut scores allow for a rating of typical performance, probable difference, or definite difference of sensory processing abilities.

Non standardized Assessment/Clinical Observation

Neuromusculoskeletal Evaluation: Clinical observation of muscle tone, joint range of motion, automatic balance responses, posture, gait and physical strength
Play Skills Evaluation: Informal evaluation of play interactions may be set up during the assessment. This is used to observe functional use of motor skills in play, and play occupations such as independent initiation, use of toys, symbolic play, creativity and imagination, and enjoyment of play. There are a limited number of occupational therapy play assessment tools, and those are largely designed for administration in the child's functional environment of home or school.
Oral-motor and Feeding Evaluation: This may include the assessment of the oral structures, oral-motor control (suck, swallow, and chew), behavioral responses during feeding, parent/child interaction, and self-feeding skills.

Service Models

• Direct service to the child and family
• Consultation to the family or other team members such as the classroom teacher
• Monitoring of performance and progress
  
  
  
  
  
  

Intervention Strategies

Occupational therapists provide intervention to children using one of five approaches.
1. Establish/Restore
The occupational therapist identifies the deficits and creates strategies to remedy the problem.

2. Adapt
The occupational therapist identifies adaptive strategies to work around the problem improve performance. When tasks, materials or environments are changed, an adaptive approach is being used.

3. Alter
The occupational therapist helps to identify an environment or physical arrangement that is more conducive for the desired occupational performance. In this situation adaptations are not made, but rather a more appropriate existing setting is identified.


4. Prevent
The occupational therapist helps to identify activities, contexts, etc. that will help prevent an undesired outcome.

5. Create or Promote
This approach is most frequently used in early intervention settings. For example the occupational therapist collaborates with families and other professionals to create an environment and routines to support optimal developmental progress and outcomes.

Examples