Student: Colin Jones Date: 16/10/14 Supervisors: Joelle O’Connell & Cathy Wyer

Using the OT Process to PromoteFunctional Performance in School

Introducing Alan:

Objectives of Case-Study:

1. Demonstrate how the OT Process is applied to a client presenting with Global

Developmental Delay.

2. Discuss use of clinical reasoning skills throughout the process.

3. Describe how the client’s function in the school environment was promoted from an

OT perspective.

The OT Process

• Townsend et al (2011)

Referral

Occupational Profile

Assessment Goal Setting

Intervention Plan

InterventionMonitor & Modify

Evaluate Outcome

Conclude

ReferralReferral from teacher outlined areas

requiring support:

Handwriting – Needs support. Writing not on the line.

Fine Motor Strength – Difficulty using Theraputty.

Balance – Wobbly at times.

Attention Span – Distracted at times and not appropriately engaged in class activities.

Occupational Profile

Person:

Youngest in family of 5 boys, 3 girls. Twin.

Enjoys singing, drama, Star Wars, Lego Ninjaga, swimming, Minecraft.

Plays during yard, one good friend. Works alone in class.

Global Developmental Delay: Disturbance in a child across

one or more developmental

domains, which include motor,

cognition, daily activities,

speech and language (Patil et al,

2014).

Person

Environment

Occupation

Environment:

School environment

Social environment

Occupation:

Education

Social Participation

Play

OCCUPATIONAL PERFORMANCE

• Law et al (1996)• Patil et al (2014)

Assessment

Occupational Performance Issues:

1. Demonstrates anxiety at times, especially in new situations. Usually requires graded introductions to new

classes.

2. Reported to have difficulty engaging in social situations and challenges with

transitions between classes.

3. Handwriting - poor letter formation is affecting progress in class.

Goal-Setting

2.Sensory-Based Intervention

• Long-term: Improve ability to self-regulate and function in classroom environment.

• Provide sensory input (proprioceptive and vestibular) for Alan during weekly OT session.

• 4 Week Goal: Improve ability to attend to tasks in class (Feedback with teacher).

1.Handwriting Without Tears

• Long-term: Improve handwriting ability in class.

• Work on fine motor function and letter formation using multi-sensory approach.

• 4 Week Goal: Reproduce Frog Jump Capitals F, E, D and P independently in class.

Sensory-Based InterventionsSensory Integration Framework

• Includes perception, modulation, and integration of sensory information as a foundation for participation in activities across social, physical, learning and daily living tasks (Ayres, 1972).

Sensory-Based Interventions

• Sensory-based interventions applied in the school environment may not have any benefit (Case-Smith et al, 2014).

• No effects from multi-sensory stimulation (Devlin et al, 2009, 2011, cited in Case-Smith et al, 2014).

• Fazlioglu & Baran (2008), cited in Case-Smith et al (2014), found strong effects in reducing sensory problems. No double blind testing or fidelity measures.

Intervention Plan

1.Handwriting Without Tears

• 4 Week Goal: Reproduce Frog Jump Capitals F, E, D and P independently in class.

• Weekly session with student OT focusing on Frog Jump Capitals.

• Feedback with teacher to confirm skills are transferred.

2.Sensory-Based Intervention

• 4 Week Goal: Improve ability to attend to tasks in class (Feedback with teacher).

• Weekly session with OT and student OT focusing on activities that provide proprioceptive and vestibular feedback.

• Feedback with teacher to confirm if attention to class activities and social interactions improve.

Intervention

Monitor/Modify

Aim to design a “just right” challenge for Alan

Zone of optimal engagement

• Anzalone & Ritchey (2013)

Evaluate Outcome

Evaluate progress after four week block. Feedback with teacher, SNA and Mum.

Handwriting: Reported to have improved noticeably in class.

Improved ability to attend to task in class following movement-based sensory sessions with SNA in morning. Reported to have increased social interactions on bus following OT sessions.

Both sensory-based interventions appear effective at this stage.

Conclude

Handover of Handwriting programme to SNA. Debrief with Mum, teacher and provision of intervention summary and strategies sheet for all parties.

OT and SNA to continue to progress with sensory-based sessions.

Questions

References

Anzalone, M. E., & Ritchey, M. (2013). Developmental and Dyadic Implications of Challenges With Sensory Processing, Physical Functioning, and Sensory-Based Self-Regulation. Infant and Early Childhood Mental Health: Core Concepts and Clinical Practice, 209.

Ayres, A. J. (1972). Improving Academic Scores through Sensory Integration. Journal of Learning Disabilities, 5(6), 338-343.

Case-Smith, J., Weaver, L. L., & Fristad, M. A. (2014). A systematic review of sensory processing interventions for children with autism spectrum disorders. Autism, 1362361313517762.

Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L. (1996). The person-environment-occupation model: A transactiveapproach to occupational performance. Canadian Journal of Occupational Therapy, 63(1), 9-23.

Patil, R. B., Urs, P., Kiran, S., & Bargale, S. D. (2014). Global developmental delay with sodium valproate-induced gingival hyperplasia. BMJ case reports, 2014, bcr2013200672.

Townsend, E. A., Polatajko, H. J., Craik, J. M., & von Zweck, C. M. (2011). Introducing the leadership in enabling occupation (LEO) model. Canadian Journal of Occupational Therapy, 78(4), 255-259.