WHAT IS OT

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WHAT IS OT?

• Elisa Wern, OTR/L

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Occupational Therapy

• Related service under IDEA
• IDEA 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 childs
  education

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Where do OTs work?

• Schools
• Rehabilitation centers
• Early intervention centers
• Hospitals
• Day care centers
• Psychosocial disorder treatment centers e.g.
  Shands at Vista

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How are OTs 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

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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.

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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 dysfunction
• visual / perceptual motor difficulties
• sensory motor integration problems
• self-feeding skills deficits

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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)

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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

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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 students natural setting in
  this case, the classroom

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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.

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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

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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 Machines
• may co-treat with SLP to work on feeding issues

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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

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Gross Motor Skills Motor Planning/Coordination

• Dyspraxia difficult motor planning
• Some kids have a hard time knowing how to get
  their bodies to do what they want to-- whether
  thats swinging on a swing or walking to a
  teachers desk from theirs
• we break down the steps and teach child one at a
  time, or in clumps

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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

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Visual Perceptional Skills

• Visual Sequential Memory Deficits
• Assignments are forgotten
• Forgets steps that are shown in an activity
• Cannot remember the alphabet in correct order
• Position in Space Deficits
• Inconsistent symbol reversal
• Transposes number or letters
• Difficulty differentiating between b,d,p,q
• Spatial Relations Deficits
• Trouble with right/left
• Difficulty with spacing within and between
  words.
• May knock over items
•  
• Visual Discrimination Deficits
• Matching and sorting difficulties
• Size discrimination may be impaired
• Fails to recognize similarities and differences
  in objects

• Visual Motor Coordination Deficits
• Difficulty drawing geometric symbols
• Difficulty in copying
• Decreased legibility in handwriting
• Difficulty with mazes and dot-to-dot
• Figure-Ground Deficits
• Difficulty with hidden pictures
• Cannot focus on one word on a page
• Difficulty copying from a board
• Trouble finding place on the page
• Visual Closure Deficits
• Cannot complete partially drawn pictures or
  stencils
• Trouble completing age appropriate puzzles
• Difficulty in spelling
• Leaves out parts of word or entire words
•  
• Visual Memory Deficits
• Trouble remembering sight words

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ADD ADHD

• Attention strategies
• Often involves behavioral plans, and consultation
  with parents and teachers

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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

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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

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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.)

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Sensory Diet

• Children with sensory modulation disorders can
  use a sensory diet
• sensory modulation is a continuum
• The ALERT program How does your engine run?

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Resources

• www.aota.org American Occupational Therapy
  Association
• www.hp.ufl.edu/ot UF OT website
• My email ewern_at_fdn.com
• Please feel free to email me questions, at any
  time!