Unit 1: Occupational Therapy
1.1 Concept of Occupational Therapy – definition, aims, scope
1.2 Modalities of Occupational Therapy in classroom setting
1.3 Hand Functions – types of grasps, grip, development, and eye-hand coordination
1.4 Sensory – perceptual motor skills – nature, development, importance
1.5 Sensory Integration
1.1 Concept of Occupational Therapy – definition, aims, scope
Occupational therapy (OT) treatment focuses on helping people with a physical, sensory, or cognitive disability be as independent as possible in all areas of their lives.
In OT, occupations refer to the everyday activities that people do as individuals, in families and with communities to occupy time and bring meaning and purpose to life.
The primary goal of OT is to enable people to participate in the activities of everyday life.
Occupational therapy interventions focus on adapting the environment, modifying the task, teaching the skill, and educating the person in order to increase participation in and performance of daily activities, particularly those that are meaningful to the person.
Occupational therapists often work closely with professionals in physical therapy, speech therapy, nursing, social work, and the community.
Children who need OT
According to the AOTA, children with the following medical problems benefit from OT:
- birth injuries or birth defects
- sensory processing disorders
- traumatic injuries (brain or spinal cord)
- learning problems
- autism/pervasive developmental disorders
- juvenile rheumatoid arthritis
- mental health or behavioral problems
- broken bones or other orthopedic injuries
- developmental delays
- post-surgical conditions
- burns
- spina bifida
- traumatic amputations
- cancer
- severe hand injuries
- multiple sclerosis, cerebral palsy, and other chronic illnesses
Objectives of Occupational Therapy
Through the years, three general objectives of occupational therapy have evolved:
§ Diversion: The primary objective is to divert or distract attention away from the disease or disorder toward more healthful ideas and positive thinking i.e. toward useful tasks or occupations such as painting, weaving, pottery, sewing, or woodworking and amusements which included playing games, listening to music, playing music, watching or performing plays, participating in playful exercises and sports, as well as doing a variety of arts and crafts.
§ Emotional Expression: Emotional expression, also called creative expression, became important to occupational therapy as through the use of the creative arts and crafts patients can express attitudes, feelings, and ideation, express hostility, dependency, and infantile oral and anal needs.Develop better self-concepts, improve personal identities, and build more healthy egos.
Creative arts and crafts provide opportunities of reality testing as well. The objects and processes offer sensory contact, shared values, and consensual validation.
The use of expression dominated occupational therapy in psychiatry in the 1960s and 1970s.
§ Skill building: Skill building has been a part of occupational therapy from the beginning, but its purpose has expanded in recent years. Initially, skills were primarily honed in relation to work situations.
During the 1950s, the concept of activities of daily living (ADLs) was added to the objective of skill building. Activities of daily living, also called self-care, included such tasks as dressing, grooming, walking, and eating.
In the 1970s, skill building began to be described in three or four areas called self-care or daily living skills, work or productivity, and play-leisure or recreation and three to five components called physical, motor, sensory, sensorimotor, cognitive, intrapersonal, psychological, interpersonal, social, psychosocial, or cultural. Gradually, the term ‘performance’ became a key concept.
These objectives provide the framework for more specific and more individualized goals and objectives.
Objectives of OT for Children/ Persons with Special Needs
The objectives of occupational therapy for children/persons with special needs are to:
§ help children work on fine motor skills so they can grasp and release toys and develop good handwriting skills
§ address hand-eye coordination to improve child's play and school skills (hitting a target, batting a ball, copying from a blackboard, etc.)
§ help children with severe developmental delays learn basic tasks (such as bathing, getting dressed, brushing their teeth, and feeding themselves)
§ help children and adults with behavioral disorders maintain positive behaviors in all environments (e.g., instead of hitting others or acting out, using positive ways to deal with anger, such as writing about feelings or participating in a physical activity)
§ teach children and adults with physical disabilities the coordination skills needed to feed themselves, use a computer, or increase the speed and legibility of their handwriting
§ evaluate a child's need for specialized equipment, such as wheelchairs, splints, bathing equipment, dressing devices, or communication aids
§ work with children and adults who have sensory and attentional issues to improve focus and social skills.
1.2 Modalities of Occupational Therapy in classroom setting
Occupational therapists use a variety of modalities to help
with treatment.
A modality is the employment of
therapeutic agents such as whirlpools,
hot packs, cold packs, paraffin, and fluidotherapy. The modalities either produce heat or cold and are used
for a variety of reasons.
Heat modalities are generally used as a
preliminary to a prescribed exercise or
activity. Heat helps to increase circulation to the affected area, decrease pain, improve elasticity of soft tissue
prior to stretching or exercise, and
improve joint mobility. Cold modalities
assist in reducing swelling, inflammation, and pain. Generally, cold modalities are utilized after a
treatment session, activity,
or exercise.
Cold Packs
Cold packs are generally kept in a freezer or
some type of cooling device to maintain
the packs at or below freezing. Another form of cold treatment is referred to as a cryocuff.
This device consists of a small
cooling unit attached to an inflatable cuff. The
cuff is applied to a specific body part
such as an ankle, wrist, or shoulder. Cold water runs from the cooling unit through the cuff and back to the
unit through
rubber tubing. The patient’s skin should be
checked during and following a cold
treatment to ensure that the patient’s skin is having no adverse reaction to the cold nor sustaining a cold
burn.
Individual Work
Individual therapy sessions address occupational performance areas of concern. Areas of intervention can address:
• Organisation skills
• Sensory regulation strategies
• Handwriting
• Balance & coordination
• Anxiety management
• Self care issues
Group Work
The aim of group work is to develop a positive peer culture through a supportive group environment, which fosters engagement and participation and enables the students to develop and practice positive interpersonal skills such as:
• Listening
• Turn taking
• Problem solving
• Team work
• Respect & responsibility
• Choice
• Equality
• Positive self image
1.3 Hand Functions – types of grasps, grip, development, and eye-hand coordination
Hand function has great significance for occupational performance. The greater the difficulties with hand function, the greater the impairment in skills that allow for independence and participation in academic and social activities. Children with hand function difficulties usually are limited in their ability to effectively or efficiently complete daily life skills and develop skills that will support optimal occupational performance in the future. In addition, for some children even subtle difficulties with hand skills may affect their social participation because of limitations in ability to engage in activities with their peers or messiness in task completion.
The major function of the human hand is to manipulate objects to accomplish a goal.
• The ability of a human hand to assure a myriad of position and to apply only the precise amount of pressure necessary to hold an object is due to: the mobility and stability supplied by the skeleton: the power of the muscle; the remarkable degree of sensory feedback from the nerves.
• The sensory feedback is used to asses the shape, size, texture and weight of the object. The feedback used in both grasping and lifting of an object is dependent on the brain interpreting correctly, what is seen on the hand responding appropriately.[1]
• Hand function has great significance for occupational performance. The greater the difficulties with hand function, the greater the impairment in skills that allow for independence and participation in academic and social activities
The development of grasping is an important component of child development stages, wherein the main types of grasps are:
· Raking grasp, wherein the fingers, but not including the thumb, do all the holding.
· Palmar grasp, wherein the fingers squeeze against the palm, instead of against themselves as in the raking grasp. Children are usually able to use a palmar grasp by the age of 6 months.
· Pincer grasp wherein the pointer finger and the thumb squeeze to grasp an object. Children are usually able to use a pincer grasp by the age of 9 to 10 months.
Infants reach as early as 16 weeks of age and are able to perform certain actions that lead to grasping objects. The act of grasping is a two-stage motor skill that develops. The first stage, infants will reach out towards the desired object. In the second stage, the infants will then clench fingers once the object has made contact with the palm and close. Infants try to grasp an object before it is within reach by initiating arm and hand movements. The child will extend their grip more than necessary because their perception is less developed than an adult's grip.[5] Infants progress their grasping skills throughout time by practice and providing objects that are reachable. It is essential to provide infants with objects they can grasp in order to progress and further their development of the grasping skill; exposing infants to new objects to practice grasping will overall benefit this primitive motor skill and elevate the associated cognitive process. Infants develop their reaching and grasping from making just contact with their hands, to using their palms to contact an object. Infant grasp is an extension of reaching and develops between six and nine months of age. Stable patterns of reaching in order to grasp continue to develop as the child grows and matures. By the age of 6, children are now learning hand placement on the writing utensil the correct way.
Types of Grip
The human hand is a miracle of evolution. Our elongated thumb is able to oppose our fingers, and hence manipulate objects and instruments with a far greater degree of precision than primates and other animals. The function of the hand is to grip, grasp and form precise movements, e.g. writing and sewing.
• Hammer grip
• Baseball batter grip
• Precision grip (tip to tip)
• Lateral Prehnsion
• Key grip
• Hook grip
• Tripod (pen) grip
Functional Position of Hand
• It is the position where the hand is immobilized to interact with the surroundings.
• This position is also used for non functioning hand for splint usage.
• It helps the non functioning hand to prevent contractures.
• Due to the hand's remarkable adaptability to functional requirements, as compared with the specialization in the forelimb of other animals, the hand is largely responsible for the creative manifestations that characterize the human species and that distinguish it from all other known forms of life.
• The human arm, supported and controlled by a large number of muscles, together with the elbow and wrist joints, gives freedom to a hand that has become the willing servant of the human intellect. The hands are, as Kant is reported to have said, "man's outer brain."
Eye-hand coordination
Hand-eye
coordination is the ability of the vision system to coordinate the information
received through the eyes to control, guide, and direct the hands in the
accomplishment of a given task, such as handwriting or catching a ball.
Hand-eye coordination uses the eyes to direct attention and the hands to
execute a task.
Vision is the process of understanding what is seen by the eyes. It involves
more than simple visual acuity (ability to distinguish fine details). Vision
also involves fixation and eye movement abilities, accommodation (focusing),
convergence (eye aiming), binocularity (eye teaming), and the control of
hand-eye coordination. Most hand movements require visual input to be carried
out effectively. For example, when children are learning to draw, they follow
the position of the hand holding the pencil visually as they make lines on the
paper. Between four and 14 months of age, infants explore their world and
develop hand-eye coordination, in conjunction with fine motor
skills . Fine motor skills are involved in the control of small muscle
movements, such as when an infant starts to use fingers with a purpose and in
coordination with the eyes.
Infants are eager to move their eyes, their mouths, and their bodies toward the people and objects that comfort and interest them. They practice skills that let them move closer to desired objects and also move desired objects closer to themselves. By six months of age, many infants begin reaching for objects quickly, without jerkiness, and may be able to feed themselves a cracker or similar food. Infants of this age try to get objects within their reach and objects out of their reach. Many infants are also able to look from hand to object, to hold one object while looking for a second object, and to follow the movements of their hands with their eyes. At this age, most infants begin to poke at objects with their index fingers. After six months, infants are usually able to manipulate a cup and hold it by the handle. Many infants at this age also begin to reach for objects with one arm instead of both. At about eight months of age, as dexterity improves, many infants can use a pincher movement to grasp small objects, and they can also clap and wave their hands. They also begin to transfer objects from hand to hand, and bang objects together.
1.4 Sensory – perceptual motor skills – nature, development, importance
Sensory processing is how the brain registers, interprets, and uses information gathered through the senses: sight, hearing, taste, touch, smell, body awareness and balance. Sensory input is thought to have a mediating effect on arousal and alertness states, and we need sensory input for the brain to develop and function. Everyone has sensory preferences, and it is important to understand our own in order to understand and support the sensory needs of others.
Occupational therapists often work with children with sensory processing difficulties in order to improve their ability to process and integrate sensory information, which in turn creates a foundation for improved independence and participation in the activities of daily life, play and school.
Perceptual-motor skills and movement concepts are essential to all facets of young children’s lives. Perceptual-motor coordination is the process of receiving, interpreting, and using information from all of the body’s senses. Perceptual-motor development requires children to integrate both sensory and motor abilities to carry out physical activities. All voluntary movement involves an element of perception, and perceptual-motor coordination plays an important role in children’s development of movement skills.
Movement concepts are the cognitive component of movement. Preschool children gain important knowledge about how the body can move in an almost endless variety of ways. For example, they learn to move at different speeds and with different degrees of force, in various pathways, around different types of obstacles, and in relation to other people. They are also acquiring new vocabulary (e.g., zigzag, under, or behind) that describe their movement experiences. Movement concepts enable children to problem-solve how the body should move during certain activities and situations. Movement concepts provide critical foundations for learning how to move in novel situations (e.g., when playing a new sport). To become proficient movers, children need to acquire both the movement skills and the movement concepts underlying those skills.
Children enter preschool with various experiences and abilities in perceptual-motor coordination and understanding of movement concepts. Children’s growth in perceptual-motor skills and movement concepts leads to increased success and confidence when exploring, performing personal care, and playing cooperatively with others. Perceptual-motor skills and movement concepts are also key building blocks for future learning in areas such as reading, writing, and mathematics.
Perceptual-motor skills and understanding movement concepts includes body awareness, spatial awareness, and directional awareness.
Body Awareness
Children’s knowledge of their bodies becomes more accurate and specific. They develop a clear understanding of how body parts interrelate (e.g., the shoulder connects to the arm, which connects to the hand). Children are also learning to identify, describe, and differentiate an increasing number of body parts. Furthermore, they can demonstrate different ways to move specific body parts (e.g., the shoulder can move up and down, out to the side, or in a circular motion). Body awareness is necessary for coordinating physical movements when new skills are being learned, such as hopping or throwing. Accurate knowledge about body parts also enhances children’s ability to care for their own bodies, such as during toileting, bathing, and dressing.
Children’s understanding of their location and the location of objects and people around them. Preschool children are learning to judge how much space their bodies and other objects take up and whether something is “close” or “far.” They are also developing vocabulary for describing the position of two objects relative to one another, such as whether a ball is “in front of” or “behind” them. Children gain awareness of their body dimensions and body position by physically exploring their world and by maneuvering around different obstacles (both people and objects) during play.
Children’s understanding of what it means and how it feels to move up, down, forward, backward and finally sideways. Most preschool children begin to understand that their bodies have two sides but cannot yet identify the left or right side of their body. Children are also learning to identify the top, bottom, front, or back of objects, but they do not clearly understand that objects have a left or right side. Preschool children also enjoy following pathways on the floor or creating their own movement pathways, such as straight, curved, or zigzag.
1.5 Sensory Integration
Occupational performance difficulties due to sensory modulation challenges or poor integration of sensation can result from difficulties in how the nervous system receives, organizes, and uses sensory information from the body and the physical environment for self-regulation, motor planning, and skill development. These problems impact self-concept, emotional regulation, attention, problem solving, behavior control, skill performance, and the capacity to develop and maintain interpersonal relationships. In adults, they may negatively impact the ability to parent, work, or engage in home management, social, and leisure activities.
Occupational Performance Indicators of Sensory Integration and Processing Problems
|
Sensory Systems |
Performance Skills |
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Somatosensory (Tactile & Proprioceptive) ■ Sensitive to texture and fit resulting in avoidance of some types of clothing (e.g., ties, turtlenecks, pantyhose). ■ Dislikes crowds or jostling in public places (e.g., standing in lines or shopping). ■ Becomes irritated with light or unexpected touch. May have difficulty with intimate touch. ■ Limited engagement in food and meal preparation and/or variety in diet. ■ May not discriminate when clothes are askew or food is on their face. Vestibular ■ Difficulties with balance, dislike of walking on uneven surfaces. ■ Dislikes or disoriented in elevators or on escalators. ■ Becomes nauseous when riding in the car. Needs to ride in the front seat or be the driver. ■ Fearful of leaving the house or of flying. Auditory ■ Sensitive to loud sounds. ■ Irritated by sounds not usually bothersome to others (e.g., pencils or pens scratching, lights buzzing, others eating, candy wrappers rustling).
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Motor Performance ■ Difficulty driving, parking, shifting gears, or entering a freeway with an automobile. ■ Difficulty managing common home and office equipment. ■ Clumsy or awkward with motor activities (e.g., exercise, leisure, self-care tasks). ■ Difficulty organizing and planning materials and environment, possibly impacting work performance and health and safety at home. ■ Difficulty following directions for community navigation. Social Performance ■ Difficulty discriminating visual and auditory cues, impacting social interactions and role performance. ■ Difficulty with body awareness, affecting body boundaries and body image. ■ Difficulty discriminating sounds and following verbal directions. ■ Difficulty managing self-care and hygiene. Emotion Regulation ■ Difficulty discriminating visual and auditory cues, decreasing the ability to understand the emotional expressions of others, resulting in frustration, anxiety, and anger management issues. ■ Difficulty developing adaptive sensory-based physical supports (i.e. exercise, environmental adaptations) for emotional regulation. |
Occupational performance concerns due to poor integration and processing of sensation may occur in isolation, contribute to, or be comorbid with other conditions such as anxiety and panic disorders, depression, posttraumatic stress disorder, or schizophrenia. Those with learning disabilities, attention deficit disorder, developmental disabilities, or autism spectrum disorders may also have these difficulties.
Occupational therapists have unique training and skills in neuroscience, anatomy, and activity/environmental analysis to identify and treat occupational performance issues resulting from sensory modulation, sensory integration, motor, and psychosocial deficits in adults experiencing difficulties with sensory functions. They work with caregivers and medical, educational, and mental health professionals to increase awareness of the signs and symptoms of sensory-related problems and types of interventions used with adults.
Sensory Integration, however, specific approaches vary greatly depending on the person’s needs and may include the following:
• Remedial Intervention involving the skilled use of sensory and motor treatment activities and equipment, including engagement in activities that provide increased tactile, proprioceptive, and movement opportunities, such as suspended equipment (e.g., various swings), intensified physical activities, engagement in mediated tactile experiences (e.g., cooking, massagers); and activities that promote motor planning, organization of time and space, bilateral integration, and postural-ocular skills.
• Accommodations and Adaptations such as wearing ear plugs or noise cancelling headphones, or using a loofa sponge when showering, to manage hyper sensitivities and improve attention, self-regulation, or organizational difficulties to increase effectiveness in performing school, work, household management, or parenting tasks.
• Sensory Diet Programs involving a daily routine/plan with a menu of individualized, supportive sensory strategies (e.g., rocking chair, quiet space, aromatherapy, weighted blanket), identified physical activities (e.g., yoga, swimming) and materials (e.g., sensory kits containing music, stress balls, items for distraction). These are used throughout the day as needed to help manage sensory modulation problems (e.g., touch, movement, visual or auditory sensitivity) and related emotions and behaviors, such as anxiety or self-injury, to help change sensory processing patterns, minimize crisis escalation, or promote calming for overall health and wellness (Champagne, 2010).
• Environmental Modifications and adaptations such as lighting, use of white noise machines, wall murals, and other types of furnishings and equipment to increase or decrease the sensory stimulation a space provides. In some settings, sensory rooms, sensory stations, or sensory carts may be used to achieve these goals.
• Education of individuals, family members, caregivers, administrators, and policymakers about the influence of sensory functions on occupational performance and how to minimize their negative impact on function; proactively help prevent and deescalate maladaptive behaviors; and, in some settings, decrease the need for the use of seclusion or restraint.
Conclusion
Occupational therapy plays a vital role in identifying and treating occupational performance challenges due to sensory integration and processing problems in adults and supporting their ability to fully participate in meaningful life roles, routines, and important daily activities. Administrators and organizations benefit from working with occupational therapy practitioners to enrich the services offered to adults.