Occupational Therapy

OT Terminology

Compensatory Strategies are activities designed to compensate for or to offset a deficiency.

Kinesthesia is the sense that detects body position, weight, or movement of the muscles, tendons and joints.

Proprioception is the unconscious perception of movement and spatial orientation arising from stimuli within joints and muscles.

Self regulation is the ability to attain, maintain, and change level of alertness appropriately for a task or situation.

Sensory Integration is the organization of sensation for use. The central nervous system receives, filters, organizes and integrates stimuli in order for an individual to make an "adaptive response".

Vestibular is sensation from the influence of gravity and movement.

Visual-motor integration is the degree to which visual perception and finger-hand movements are well coordinated. Visual-motor integration is commonly measured by copying shapes.

Frequently Asked Questions

What is occupational therapy?

GUIDELINES FOR OCCUPATIONAL THERAPY SERVICES

The purpose of this document is to clarify eligibility guidelines for occupational therapy services in the Chappaqua Central School District. Occupational therapy is provided to facilitate a student's ability to adapt to and function in an educational program. An occupational therapy program may be designed to assist in developing underlying skills that support academic learning or to help in the acquisition of specific skills. The presence of a disability does not necessarily indicate a need for occupational therapy. For example, if a child shows limited upper extremity strength or range of motion, occupational therapy is educationally relevant only if that lack of strength or range impacts upon functional skills, e.g., independent transfers, ability to manipulate classroom tools and/or independent toileting.

Occupational therapists address the daily occupations of school life. Occupational therapy may include interventions to improve gross and fine motor skills, to organize and use materials appropriately, to interact with peers, to attend to and focus on instructions or directions, to learn daily living skills and, when necessary, to use assistive technology or compensatory strategies. As a related service, occupational therapy must be educationally relevant and necessary. The American Occupational Therapy Association identifies performance areas that can be addressed by occupational therapists (work, leisure and self-care) and the performance components that contribute to capacity to develop skills in these areas. The following are examples of students who may require occupational therapy services:

	Those students who have difficulty modulating their responses to environmental stimuli and are unable to attend to classroom lessons, stay in their seats, or tolerate close physical proximity to their peers.
	Students who, because of poorly developed body schema have trouble organizing their bodies when learning new motor tasks, and developing spatial concepts.
	Students who have problems with fine motor coordination who cannot effectively write, cut and construct.

Who is eligible for occupational therapy?

ELIGIBILITY

Students who may require occupational therapy service include:

Children whose classroom performance is significantly below the functional level of his/her classroom peers. These functional activities may include nonacademic aspects of a school program, including manipulating books and tools for writing or moving about the classroom and school.
Children whose scores on standardized tests of performance components (gross motor coordination, dexterity, visual-motor integration, sensory processing) or performance areas (activities of daily living, educational activities such as handwriting) fall 1.5 standard deviations below the mean.
Previous attempts to alleviate the problem have not been successful.
Potential for change in student's problem through intervention appears likely.
Unique experience of therapist is required to meet student's identified needs.

How do I refer a student to occupational therapy?

REFERRAL PROCEDURES

1. Child Study Team (CST). A teacher or related staff member may refer to the Child Study Team if the presenting problem has an educational impact. The CST will then determine if an occupational therapy evaluation will be recommended. The occupational therapist will conduct an evaluation and recommend services as necessary.

2. Committee on Special Education (CSE). The CSE is responsible for determining a child's eligibility for special education and related services. The CSE can refer a child for an occupational therapy evaluation. Services recommended by the CSE are mandated by law.

3. Section 504. This law provides for accommodations and/or modifications to meet the needs of disabled students as adequately as those of non-disabled students. Students may be eligible for Section 504 protections when a disability substantially limits a major life activity in school and mandated adaptations are needed to prevent discrimination. Referrals are made through the 504 committee.

How frequently are services provided?

CONTINUUM OF SERVICES

1. Service provision options

	Direct therapy refers to those intervention activities that are individually designed and are carried out by the therapist and one child, or the therapist and a small group of children.
	Monitoring refers to the following: the therapist carries out an assessment to identify the strengths and needs of the child. The therapist designs an intervention plan to be carried out by another staff member and remains responsible for the outcome of the plan, e.g., a child may have a self-feeding program that is established by the occupational therapist and carried out by the classroom aide on a daily basis.
	Consultation differs from direct therapy and monitoring in that the therapist is using his or her expertise to enable another person to address issues and outcomes identified by that person. This model is most appropriate when there is little or no need for direct interaction between the student and therapist in order to address goals.

2. Service intensity

Services are most often provided 2 times per week for 30-minute sessions. Frequency is determined by such factors as: number of performance components contributing to the dysfunction, severity of the problem, rate of progress, and impact of removal from classroom on academic performance. Students are seen either individually or in small groups depending on the value of peer interaction in achieving specific goals and/or the necessity for individual attention/physical interaction with the therapist.

Service intensity is likely to be greater in early education. At that time, treatment addresses not only specific performance areas but also the neurodevelopmental foundations that contribute to holistic growth. Students in intermediate grades are more likely to receive services of less intensity, and goals address acquisition of specific skills such as vocational or graphomotor skills. Brief and intermittent intervention may also be provided to problem-solve accomplishing a particular task.

3. Mode of delivery

	Integrated services are provided in the classroom or in the context in which the targeted skill naturally occurs.
	Pullout service is provided when integrated services would be disruptive to other members of the class, or when foundation skills need to be developed before the target task can be successfully addressed.

When are services discontinued?

DISCONTINUATION OF SERVICES

The following are indicators that therapy is no longer indicated:

	The student has met educationally relevant therapy goals and can participate independently in the areas of concern.
	Adaptations or accommodations have been provided to facilitate independence.
	The problem has ceased to be educationally relevant.
	Teacher/parents have learned and can carry out appropriate techniques to assist the student.
	The student progress has plateaued/potential for further change is unlikely.

Student Activities

Activities to Improve Pre-writing Skills

HANDWRITING

ACTIVITIES TO IMPROVE PRE-WRITING SKILLS

1. Wheelbarrow walking-child's hands are on floor, pick up feet and "walk" child on his/her hands.

2. Pouring from small pitcher to specific level in clear glass. Increase size of pitcher as strength increases.

3. Rope turning/jump rope

4. Slinky--shift back and forth with palm up.

5. Volleyball-type activities where hands, paddles, or rackets are in palm-up position. (Balloon volleyball)

6. Floor activities--large mural painting, floor puzzles, coloring when lying on stomach on floor.

7. Working on a vertical surface, especially above eye level. Activities can be mounted on a clip board or taped to surface or chalkboard/easel. Examples: pegboards, Lite Brite, Etch-a-sketch( upside down), Magna doodle, outlining, coloring, painting, writing.

8. Clothespins/pinching. Put letters on clothespins and spell words by clipping on edge of shoe box. Use a clothespin to do finger “push-ups” by using the pads of the thumb and index finger to open a clothespin and count repetitions.

9. Bead stringing/lacing with tip of finger against thumb

10. Inch a pencil or chopstick positioned in tripod grasp toward and away from palm. The shaft should rest in open web space.

11. Squirrel objects into palm (pick up with index finger and thumb, move into palm without using the other hand)

12. Squirt bottles.

13. Use tongs/tweezers to pick up blocks/small objects

14. Pennies into piggy bank or slot cut in plastic lid. Coins can also be put into slots cut in foam.

15. Finger plays/string games such as Cat's Cradle

16. Screw/unscrew lids

17. Squeeze sponges to wash off table, clean windows, shower, etc.

18. Playdough/silly putty activities

19. Pop bubble wrap

20. Use a turkey baster or nasal aspirator to blow cork or ping pong balls back and forth. These can also be used to squirt water to move floating object/toys.

21. Tear pieces of construction paper into small pieces and paste the different colors of paper on a simple picture from a coloring book, or make your own design.

22. Moving objects with tweezers—can use the large ones from Bed Bugs game or kitchen tongs.

23. Dot-dots, color by number, mazes.

PROPER PENCIL GRASP

One of the most common problems occupational therapists in the school are consulted about is improper pencil grasp. While the most efficient way to hold a pencil is the dynamic tripod grasp, many other patterns are commonly seen in children and it does not always require intervention or modification. In the dynamic tripod grasp, the pencil is held between the thumb and index finger, with the pencil resting on the middle finger.

Click on the document below entitled Efficient and Inefficient Grasp Patterns to see pictures of efficient and inefficient grasp patterns.

Children hold their pencils in patterns other than the dynamic tripod for a variety of reasons. One common reason is participating in a lot of writing before their hands are developmentally ready for this activity. For activities to develop hand skills, see above activities.

It is important to try to modify the pencil grasp as early as possible, since many students seem to have developed bad habits even before entering kindergarten. Adaptive pencil grips may be helpful in teaching students to modify their grasp. There are many different types of grips available. For a pencil grip to be effective, the student needs to be involved in choosing the grip and to understand the importance of using it.

PROPER WRITING POSITION

The most optimal position for writing includes the ankle, knee and hip at right (90 degrees) angles with the forearms resting on the desk. The top of the desk should be approximately 2 inches above the elbows when the arms are at the student's side.

Activities to Increase Level of Alertness

Sensory Strategies

Activities to Increase Level of Alertness

Carrying heavy objects

(gallon jugs filled with sand, backpacks, heavy box, books to library)

Crawling/Climbing:

playground equipment provides a variety of climbing challenges

Moving chairs from on top of table to floor

Pushing heavy objects

Drawing in clay

Jumping on floor or trampoline, jumping rope, jumping jacks

Hopscotch

Wheelbarrow walking

Pushing wall/chair push-ups

Crunches

Monkey bars, teeter totter, walking uphill

Push/pull toys and games:

loaded boxes, wagons, wheelbarrows, furniture, vacuum, push broom.

Animal walks:

crabwalk, frog hop, duck walk, bear walk, monkey walk, seal walk

Putting something in mouth e.g. strongly flavored hard candy, chewy candy (starburst, hot tamales, Mike and Ike) or gum

Crunchy foods e.g. pretzels,

Listening to up-beat music

Calming Activities

Keeping lights low and sitting “snuggled” in a small space.

Scents such as lavender and vanilla may be calming.

Use oral input: sweet tastes/sucking are relaxing.

Drinking water out of a straw (sports bottle)

Listen to slow, rhythmical music.

Wrap child snugly in blanket or towel. (do not place over child’s head)

Make a “quiet corner.” Have a tent with a beanbag chair and blanket inside. Use only for quiet things such as reading, or getting composure when upset.

Make a “pizza” on your child. Knead the “dough” with deep pressure massaging on arms, legs and back. Firmly press on pepperoni, sauce, cheese or whatever else child wants.

Make a “sandwich” by placing child’s body (not head) between two pillows and giving deep pressure. Take care not to press too hard and hurt child. Always respect child’s cues.

Rock child slowly in a hammock. Place a blanket on them if they wish. Play relaxing music and dim lights.

Visual Motor Spacing

Spacing

1. Have student write on graph paper, one letter per box and one box between words.

2. Have student insert a colored line or highlighter dot between words.

3. If using the index finger of the non-dominant hand isn't successful, try making a spacer with a

Popsicle stick or tongue depressor. Making these spacers could be a classroom or home activity in which the students decorate and/or name their spacer.

4. Place dots between words with a pencil, then erase the dots

5. Teach student to review their own work to determine if there are spaces between the words. If they don't have spaces they can use a highlighter to add them.

6. Some students respond better to concrete instruction such as, "Move your pencil over before you start the next word."

7. Highlight right margin if student crams words on right side of paper rather than dropping down to next line.

8. Highlight both margins (left one green and right one red) or use Wikki Stix to teach the student to bump the margins with his or her pencil.

9. Write the sentence "ca nyo up layb all? Ask the student to read this exactly as it is written. When child can't read it, tell him/her that this is due to the fact that the spaces are not in the correct place. Have him/her re-write the sentence with correct spacing.

10. Suggest to a child to write X amount of words per line across. The first few times they have half the line left for that last word.

11. Exaggerate spaces between words of model that the child will copy from.

Visual Tracking

Visual Tracking

1. Ball activities

2. Large chalkboard drawings: make roads for small vehicles to drive on incorporate writing with favorite stops, such as "M" for McDonald's, "W" for Walmart, or the whole word)) then progressing to fine tasks (connect the dots, mazes, etc).

3. Use tracing paper to trace and color simple pictures.

4. Flashlight chases, starting on the floor lying on your backs and having the child chase your flashlight beam with his/hers. Lying down aids in keeping the head still and is easier.

5. Have student go through a page of print (according to reading level) and circle all the a's, etc.

Visual Memory

Visual Memory

1. Letters made from glue, glue/sand, or puff/fabric paint. Add food coloring to a bottle of paint/glue (not the washable kind). Stir and keep bottle upside down overnight to mix well. Write the letter on an index card with a pencil and have child squeeze bottle to form the letter, making sure the letter is formed properly. When the glue/paint dries, it forms a raised letter for tactile input. Have child trace the raised letter 3x with index finger of dominant hand.

2. Use glue to write letters on wax paper or glass, let dry and peel off letter. Can add sand and/or color.

3. Write in sand, putty, pudding, on carpet squares, etc.

4. Wikki Stix over letters written on index cards. Can also form letters out of wikki sticks, putty, by moving body parts into "letter shape", etc.

5. Write letters on index card with black marker. Make a green dot with marker as starting point and red dot as stopping point for letter. Then put a thin layer of glue over the letter and dry overnight.

6. When using classroom triple-lined paper, highlight bottom and dotted middle lines. Top line is where capitals and tall lowercase letters begin.

7. Have the child first trace a really large letter on the board, then make the letter independently, and then write the letter with their eyes closed. It can increase the interest/sensory feedback if you are able to do this over a bumpy surface such as an air vent cover or a piece of nylon net.

Reversals

Reversals

1. Check to see if child has L/R discrimination on self, others and in space.

2. Use HWT method of small chalkboard with boundaries and beginning under smiley face (placed in top left-hand corner of board frame).

3. Develop consistent use of left to right direction using a variety of media.

4. Bilateral integration activities.

5. Use the "Cognitive Override" (strategies to help the child see and feel the difference between the letters commonly reversed, such as "b" and "d". Instead of a ball-and-stick method of writing these letters, the child uses a continuous stroke to first make the vertical stroke of the letter "b", followed by the closed loop to complete the letter, reciting the "b" is for a bat and a ball -- you need the bat first, and then the ball. The "d" is made by first the letter "c" with a continuous stroke to complete the vertical stroke, reciting the "c is followed by d"). The students associate differing kinesthetic feedback for the two letters and build up a cognitive strategy to differentiate between them. Use the cognitive override strategies esp. if child is beyond second grade.

6. For the letters "a, d, g, and q" and the number "9," I cue the child to use "c up down" as the method of forming these letters. For the number "3" the cue that seems to work is: "around the tree, around the tree".

7. Have the child first trace a really large letter on the board, then make the letter independently, and then write the letter with his or her eyes closed. It can increase the interest/sensory feedback if you are able to do this some over a bumpy surface such as an air vent cover.

Ideas to Improve Cutting Skills

IDEAS TO IMPROVE CUTTING SKILLS

	Pretend the scissors are alligators taking big chomps.
	Cut playdough, gak or silly putty
	Cut ends of licorice to make straws; cut tops off fruit snacks, cut up pieces of string cheese, etc.
	Cut up straws to make beads
	Cut strips to make paper chains
	Cut up magazine pictures to make puzzles
	Use cutting projects to make finger puppets, paper airplanes, etc.
	Go outside and cut grass or dandelions with scissors, a good spring activity!
	Tape large sheets of paper around the top of a small table and have children sit on the floor and cut up to the top to make fringed sides.
	To make cutting fun, draw an eye on each side of the paper and pretend the scissors are sharks, dinosaurs (or other favorite animal) that are hungry.
	Cut up junk mail!

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