What is an Occupational Therapist?
An occupational therapist (OT) is a highly trained medical professional who evaluates and treats children and adults who have difficulty participating in meaningful activities (or “occupations”) relevant to their daily lives. Although many people often think of “occupation” as work or a job, occupation can mean any activity a person engages in. This can include self-care, play and leisure activities, and work. For a child, “work” often involves playing, learning, and going to school.
Children make up a large part of the population receiving OT services. Treatment often focuses on improving a child's development in the areas of fine motor skills (e.g., stringing beads, cutting with scissors, buttoning buttons), play skills, social skills, and self-care skills (e.g., dressing, bathing, grooming, and feeding).
Generally, occupational therapists provide treatment to clients who have been diagnosed with a specific medical condition by a physician. Diagnoses may include learning disorders, stroke, traumatic brain injury, autism spectrum disorders, sensory processing disorders, cerebral palsy, Down syndrome, attention deficit hyperactivity disorder (ADHD), genetic disorders, and developmental delays. Based on the results of an evaluation, the occupational therapist designs a treatment plan based on each client’s and family's unique needs.
Below is a list of common problems treated by an occupational therapist.
• Decreased range of motion - limits in moving the head, neck, body, or limbs
• Decreased strength - difficulty performing age appropriate weight bearing movements (e.g., bear walk, wheelbarrow walk) and holding body positions against gravity (e.g., superman)
• Fine motor delays - difficulty with handwriting and cutting skills, using a pincer grasp to pick up small items, and buttoning a button on a shirt
• Self-care delays - difficulty performing dressing, grooming, tooth brushing, and feeding skills
• Bilateral coordination delays - difficulty using both hands together to perform a task (e.g., tying shoes, throwing/catching a ball)
• Visual perceptual disorders - difficulty organizing visual information from the environment in order to perform a task (e.g. putting a puzzle together)
• Sensory processing disorders - difficulty responding appropriately to different sensory experiences (i.e., touch, taste, sound, and movement) which interferes with the ability to perform daily activities
What is Occupational Therapy?
Occupational Therapy, or OT, is a term describing a medical profession that works with people with disabilities or those who have experienced brain or bodily trauma. Treatment or therapy is often necessary for those with common diagnoses of stroke, heart problems, brain injury, burns, or other injuries. Therapy enables individuals to participate in meaningful activities relevant to their daily lives. For example, occupational therapy often involves training of self-care skills such as dressing, bathing, tooth brushing, shaving, hand and hair washing, and feeding skills. An occupational therapist teaches and assists the patient in becoming as independent as possible with all daily tasks.
Who needs Occupational Therapy?
Children make up a large part of the population receiving OT services. Children who receive services have a range of diagnoses that may include learning disorders, autism or Asperger’s syndrome, cerebral palsy, Down syndrome, brain injury, attention deficit hyperactivity disorder (ADHD), genetic disorders, or general developmental delays. These children may receive OT at school, home, or in clinical settings. Treatment focuses on improving a child's developmental stages, play skills, social skills, and oral skills.
How does a child qualify for Occupational Therapy?
Children that have developmental delays, physical disabilities, or a sensory dysfunction may be given a referral for an OT evaluation from their pediatrician or educator. An initial OT evaluation involves administering a series of tests over a period of 1-2 hours. The therapist uses a combination of clinical observation, standardized tests, and a parent interview to determine if a child is demonstrating significant delays in order to qualify for services. Following the evaluation, a parent-staff conference is set up to review the evaluation findings, establish treatment goals and objectives, and obtain written permission from the parent and doctor for therapy.
Therapy focuses on a sensory or motor approach or a combination of these approaches to improve a child’s ability to take in and use experiences of touch, taste, sound, and movement. Treatment also includes play and social skills, incorporating hand strength, grasp, cognition and following directions.
Occupational therapists help a child develop and improve handwriting skills, visual skills, and social interaction, as well as academic skills.
For example, treatment activities for a child needing help with handwriting may include a gross motor activity involving a sensory-based task or game, a fine motor activity, and then the actual handwriting objective. Gross motor activities involve the child in animal walks, peer games, and movement to music. Sensory-based activities may include writing or drawing in shaving cream on the wall, coloring on sandpaper, and finger-painting. Therapists use fine motor activities to strengthen hands and fingers by having the child practice pinching clothespins, stringing beads, and using chopsticks. Finally, the therapist makes an analysis of the child’s seating position and choice of writing utensil. Writing practice and instruction helps the child focus on holding the pencil correctly, forming letters correctly, copying from a sample, maintaining left-to-right orientation, and using correct spacing between words.
What is Sensory Processing Disorder?
Sensory Processing Disorder (SPD), or the former but still acceptable term “Sensory Integration” (SI), is a term referring to the way the nervous system receives messages from the senses and turns them into appropriate motor and behavioral responses. Whether you are eating pancakes, riding a skateboard, or reading a book, your successful completion of any activity requires processing many different sensations.
A Sensory Processing Disorder exists when sensory signals cannot organize themselves into appropriate responses. Pioneering occupational therapist and neuroscientist, A. Jean Ayres, PhD, compares SPD to a neurological “traffic jam” which prevents parts of the brain from receiving the information it needs to interpret sensory information correctly. A person with SPD finds it difficult to process and act upon information received through the senses which, in turn, can create severe challenges in performing countless everyday tasks. Clumsiness, behavioral problems, anxiety, depression, and school failure are a few ways SPD can affect someone that does not receive effective treatment. Sensory Processing Disorder can affect people in only one sense–just touch, sight, or movement–or in multiple senses. One person with SPD may over-respond to the touch sensation and find clothing, physical contact, light, sound, food, or other sensory input as unbearable. Another might under-respond in reaction to stimulation – even pain or extreme hot and cold. Other children might exhibit appetites that are in perpetual overdrive for certain sensations. Children receiving impaired messages of sensory processing from their muscles and joints might experience poor posture and motor skills and, as a result, may have low self-esteem, experience social/emotional issues, and struggle academically. This disability is not an obvious one. People unaware of this disorder, including parents and educators, may label SPD children as clumsy, uncooperative, belligerent, disruptive, or “out of control” Without an appropriate diagnosis and therapy, anxiety, depression, aggression, or other behavior problems can follow. However, most children with Sensory Processing Disorder (SPD) are as intelligent as their peers and are sometimes intellectually gifted; the wiring of their brain is just different. Those with SPD must learn alternate ways (through therapy) to help them adapt to how they process information, and they must acquire leisure activities that suit their own sensory processing needs. Children with SPD often receive a misdiagnosis of Attention Deficit Hyperactivity Disorder and begin a regiment of medication that is not addressing their needs. Examine the symptoms of ADHD and SPD side by side, and you will see some striking parallels, as well as several disparities. The two conditions do not always go hand in hand, but they can and often do. Err on the side of caution and consult physicians and therapists who are knowledgeable about both. Once children with SPD have an accurate diagnosis, they benefit from a treatment program of occupational therapy (OT) with a sensory integration (SI) approach. Well-trained clinicians will effectively combine an Integrated Listening System or other complementary therapies with Occupational Therapy and Sensory Integration techniques. This approach typically takes place in a sensory-rich environment sometimes called an “OT gym.” During OT sessions, the therapist guides the child through fun activities that are very subtle, yet challenging. The goal of occupational therapy is to foster appropriate responses to sensation in an active, meaningful, and fun way so the child is able to behave in a more functional manner. Over time, the appropriate responses generalize to the environment beyond the clinic to include the home, school, and the larger community. Effective occupational therapy enables children with SPD to take part in the normal activities of childhood, such as playing with friends, enjoying school, eating, and dressing. Ideally, occupational therapy for SPD is family-centered. Parents work with the therapist to learn more about their child’s sensory challenges and thereby learn methods for engaging with them in therapeutic activities (sometimes called a “sensory diet”) at home and elsewhere. The child’s therapist can provide ideas to teachers and others outside the family who interact regularly with the child. Parents have the opportunity to communicate their own priorities for treatment which helps others who live and work with sensational children to understand that this disorder is real, even though sometimes it is “hidden.” With this assurance, they become better advocates for their child at school and within the community. Preliminary research suggests that SPD is something we inherit. If so, the causes of SPD are in our genetic material. Prenatal and birth complications have also been implicated, and environmental factors may be involved. As with any developmental and/or behavioral disorder, the causes of SPD are likely to be the result of factors that are both genetic and environmental. Only with more research will it be possible to identify the role of each.