WHAT IS OT?

Elisa Wern, OTR/L

Occupational Therapy

Related service under IDEAIDEA definition: OT is “(I) improving, developing or restoring

functions impaired or lost though illness, injury, or deprivation (ii) improving ability to perform tasks for independent functioning when functions are impaired or lost, and (iii) prevention, through early intervention, initial or further impairment or loss of function.” [34 C.F.R., 300.16(a) (5).]

focuses on the educationally relevant areas of ADL, work, and leisure/play.

Can be in typical school setting or in charter school, alternative schools, vocational schools or home-based related services when deemed to be most appropriate environment for the child’s education

Where do OT’s work?

SchoolsRehabilitation centersEarly intervention centersHospitalsDay care centersPsychosocial disorder treatment

centers e.g. Shands at Vista

How are OT’s trained?

4 1/2 year degree from accredited university classes in neuroanatomy, musculoskeletal

anatomy, pediatrics & development (4 courses), psychosocial illnesses, elders/geriatrics, neurorehabilitation

Two 3 month internships, with optional 4 week specialty

state and national certification and licensure

Difference between OT and PT

Both are health care professionals that treat children with developmental disabilities, adults/children with injury or diseases.

In general, the OT and PT provide assessment services, treatment and program suggestions.

The OT assesses the areas of daily living skills, upper extremity strength/range of motion, developmental delays, cognitive functioning, visual perception, work hardening skills, sensory integration and/or adaptive behavior. Treatment includes self-help skills training, upper extremity strength/endurance training, and enhancement of developmental skills.

The PT areas of focus may include joint motion, muscle strength and endurance, function of heart and lungs, and/or performance of activities required in daily living. Treatment includes therapeutic exercise, ROM, and lower extremity coordination.

Reasons for Referral in School System

Handwriting is a huge reason for referral- very large growing practice area.

daily living skills and community living skills

fine motor / upper extremity dysfunctionvisual / perceptual motor difficultiessensory motor integration problemsself-feeding skills deficits

Roles of OT

Direct service: typical therapy sessions in group or individual settings

Consultative: to child who does not qualify for direct service, consult may be used to monitor and assess needs of child in class

Consult to teachers: often we are approached with scenarios of “I have a student who is having problems with X, what suggestions do you have? (Pre-referral checklist)

Words you Might hear

ADL: activities of daily living FM: fine motor skills – writing, manipulating

objects, using hands to complete ADL tasks such as brushing hair, putting on earrings…

GM: gross motor skills – running, jumping, skipping, walking…

ROM: range of motion SI: sensory integration AT: assistive technology COTA: certified occupational therapy assistant

Kinds of therapy you may see

Pull out: students are taken to another part of the classroom or school campus for therapy time, often with other children who are working on similar goals

Push in: move lately towards provision of services in the student’s natural setting – in this case, the classroom

Developmental Delays

Often used to classify children who for unknown reasons demonstrate delays in areas of fine motor, gross motor, or sensory processing skills.

OT goals may include: age appropriate scissoring or pencil grasp

DD is not used as a classification after age 6.

Mobility/Positioning

WC seating and positioning for optimum educational performance

“if you are uncomfortable, do you want to do work?”

Assist with ensuring child has maximum access to classroom environment – desks, playgrounds, specials…

Feeding

May work in classrooms at breakfast and lunch to assist students in learning ways to adapt use of utensils

Help to teach teachers and aids tools to assist student to be as independent as possible in feeding

AT -- Feeding Machinesmay co-treat with SLP to work on feeding

issues

Fine motor coordination

Involves use of hands for purposeful movements such as writing, picking up items

Dysfunction areas are in finger strength and pinch strength, finger isolation

Very interwoven with handwriting difficulties manipulating small objects using scissors turning pages using clothing fasteners opening and closing containers

Gross Motor Skills & Motor Planning/Coordination

Dyspraxia: difficult motor planningSome kids have a hard time knowing

how to get their bodies to do what they want to-- whether that’s swinging on a swing or walking to a teacher’s desk from theirs

we break down the steps and teach child one at a time, or in clumps

Gross Motor Skills

The development and use of large muscles such as trunk and legs to perform activities.

Includes balance and equilibrium sitting up straight while in chair walking on uneven and even surfaces hopping, skipping, jumping strength and endurance alternating feet when climbing stairs walking on a narrow path or balance beam

Visual Perceptional Skills

Visual Sequential Memory DeficitsAssignments are forgottenForgets steps that are shown in an activityCannot remember the alphabet in correct order

Position in Space DeficitsInconsistent symbol reversalTransposes number or letters Difficulty differentiating between b,d,p,q

Spatial Relations DeficitsTrouble with right/leftDifficulty with spacing within and between words. May knock over items

 Visual Discrimination Deficits

Matching and sorting difficultiesSize discrimination may be impairedFails to recognize similarities and differences in objectsDifficulty matching two dimension to three dimensional such as alphabet letters

Visual Motor Coordination DeficitsDifficulty drawing geometric symbolsDifficulty in copyingDecreased legibility in handwritingDifficulty with mazes and dot-to-dot

Figure-Ground DeficitsDifficulty with hidden picturesCannot focus on one word on a pageDifficulty copying from a boardTrouble finding place on the page

Visual Closure DeficitsCannot complete partially drawn pictures or stencilsTrouble completing age appropriate puzzlesDifficulty in spellingLeaves out parts of word or entire words 

Visual Memory DeficitsTrouble remembering sight wordsCopies only one letter or number at a time from the board

ADD & ADHD

Attention strategiesOften involves behavioral plans, and

consultation with parents and teachers

Sensory Impairments

Low vision technology : Braille, large print books

assist students in being able to navigate their environment successfully and independently

hearing - assist in development of programs to increase access to environment

OTHER/MISCELLANEOUS

Energy conservation and activity endurance especially with children who are classified as OHI

Splinting of extremities to allow increased function and decreased deformities

AT for children who have communication disorders such as picture schedules

Sensory Processing Disorders

condition in which children demonstrate problems regulating, interpreting or producing correct motor responses to sensation.

In order for it to be classified as a disorder or a dysfunction, the problems must impact daily living routines.

Children and/or adults must demonstrate difficulty with social participation, self-regulation, self-esteem, and/or specific sensory motor skills.

(Dr. Lucy Anne Miller, 2002.)

Sensory Diet

Children with sensory modulation disorders can use a sensory diet

sensory modulation is a continuumThe ALERT program – How does your

engine run?

Resources

www.aota.org American Occupational Therapy Association

www.hp.ufl.edu/ot UF OT websiteMy email ewern@fdn.com

Please feel free to email me questions, at any time!