What do OT’s work on with students?

As a parent you may wonder what types of things do occupational therapist work on during therapy sessions? That’s a good question. I am going to address this topic today.

Occupational therapists are trained to help people gain new functional skills or regain function that was lost due to illness or accidents. Learning new skills, relearning old skills or adapting the environment to continue to be as independent as possible is central to Occupational Therapy. Occupational Therapy believes there needs to be a balance between work, play and self-care. When working in pediatrics we know that the work of a child is play. Children need to play. Playing helps children learn about themselves, their environment and other people.

Therapists can work on gaining developmental skills from the level that the child is at. This would be a called a “bottoms up” approach. Or therapists can work from what is expected of the child at their present age level which we call a “top down” approach.

An example of a bottoms up approach would be a child that can’t sit still. Upon examination, the therapist finds out that several reflexes that are present at birth are still present upon testing. The therapist understands integrating these reflexes can help the child sit still for longer and pay attention to verbal instructions and conversations. The therapist instructs the child to move in several motor patterns that help the child integrate those reflexes. An example of a top down approach would be the following; a child is 12 years old and cannot write their name. We know developmentally a child should be able to write paragraphs. We can continue to work on writing letters of their name or we adapt their environment to achieve writing their name in other ways. We can have them learn how to dictate voice to text for answers, provide them with a stamp for their name and modify what is required for written responses at school. Maybe they would benefit from a form of a “talking device” to give answers that they can’t write.

These are the areas that OT’s can address:

1. Core Strengthening

This is the muscle strength in the center of your body, your postural control muscles including your abdominal wall, diaphragm, pelvis and lower back. Core stability is important for head control, sitting up, standing, walking and keeping you strong so that you can perform two handed activities, cross the midline, balance and perform fine motor tasks. Core strength helps you to sit up for extended periods of time.

2. Bilateral Coordination.

This is the use of both sides of your body at the same time. For example, jumping jacks, catching a ball, buttoning a shirt, putting on socks, scissors skills, stirring cake batter are just of few activities where we use bilateral coordination. Some activities require each hand to do the same thing and other times one hand does the work and the other hand stabilizes the object.

3. Fine Motor Skills

This is the coordination of the small muscle movements in the hands and fingers. Anything that you do with your hands requires fine motor skills: dressing, writing, scissors, eating with utensils, cooking, crafts, keyboarding, puzzles, etc. Fine motor dexterity is the ability to move the small muscles of the hand in a coordinated fashion. There are many categories under fine motor skills such as in-hand manipulation, isolating finger movements, translation and rotation. Fine motor strength is also needed to perform tasks. Grasp patterns for holding pencils are included in fine motor skills.

4. Visual Motor

Simply put this is eye-hand coordination. This is how we use vision to coordinate our motor output. Catching a ball, bouncing a ball, hitting a softball, cutting with scissors and copying letters are examples of visual motor skills.

5. Visual Perceptual Skills.

This is a group of skills used to gather visual information and integrate them with our other senses. This is how we make sense of what we see. Some of the categories that we may test are: visual memory, visual sequential memory, visual spatial perception, visual discrimination, visual attention, form constancy, visual attention, and figure ground. If our visual sense is not right then that can affect our motor response to our environment.

6. Handwriting Instruction due to poor Fine Motor Skills

In the school setting this is a big concern for children with poor fine motor skills. Being able to read a student’s writing is important. A multi-sensory approach to handwriting is used to help children learn to form letters the proper size and space letters and words correctly.

7. Reflex Integration.

Reflexes are repetitive, automatic movements that are essential for the development of head control, muscle tone, sensory integration and motor development. These reflexes are present in utero and infancy and become inhibited as the movements do their job. The persistence of reflexes interferes with the development of more controlled and refined movements needed for balance, coordination, posture and endurance. Cerebellum development plays a part in the inhibition of reflexes. Some reflexes are: palmar grasp reflex, Moro reflex, Tonic Labyrinthine Reflex, Spinal Galant reflex, Asymmetrical Tonic Neck reflex, Symmetrical Tonic Neck Reflex.

8. Sensory Processing/Integration Skills

This is the neurological process that organizes sensations from one’s own body and from the environment and makes it possible to use the body to make adaptive responses within the environment (A. Jean Ayres, 1989)

Sight, Hearing, Touch, Taste, Smell, Proprioception (body awareness in space, joint sense) and Vestibular (head movement in space) and Interoception (internal body) are all involved.

9. Self-Regulation Skills

This is the ability to tolerate sensations, situations and distress and form appropriate responses. Controlling emotions, thinking and behavior are self-regulation skills. These are tied to Sensory Integration. This is also related to academic achievement.

10.Activities of Daily Living

These are activities oriented towards taking care of one’s own body. This includes, dressing, eating, bathing and grooming. Parents often wish their children could gain independence in these areas.

11.Executive Functioning Skills

These are the set of abilities that are essential for thinking through and completing tasks. They allow us to problem solve, initiate and complete tasks. Some skills include Response Inhibition, Working Memory, Emotional Control, Attention, and Flexibility.

12. Prevocational Skills

These are pre- working skills needed to work at a job. Older students are usually working on these skills such as following directions, sustained attention to tasks and communication skills.

I hope this helps to clarify some of the things occupational therapist do during treatment sessions.

Jayne Prushing OTR/L