Early Intervention and Occupational Therapy

What is Early Intervention?

The term Early Intervention indicates different meanings to different professionals. In this article, we are discussing Early Intervention related to the rehabilitation of a child and role of occupational therapy in early intervention.

Early refers to the critical period of a child’s development between birth and 3 years of age. Intervention refers to the treatment program designed to improve or maintain the child’s development.

Early intervention plan for kids is very effective for those children who are at high risk of developmental delay. The goal of early intervention is to prevent the physical, cognitive, social, emotional delay because of biological risk factor (low birth weight, fetal alcohol syndrome) or environmental risk factor (parental neglect, homelessness) in the young children.

Early Intervention Team-

Early intervention service is not limited to occupational therapy. Other professional also has their own role and importance. In early intervention, the role of family members is very important. Occupational therapist should collaborate with family and other professional for better service.

The team approach is used widely in early intervention. Professionals work together as a team to deliver the range of necessary services- medical aid, nursing care, physical therapy, occupational therapy, and speech therapy.

Role of Occupational therapy in Early Intervention –

Occupational therapy is considered as a primary service for the young children who needs early support. Occupational therapist assists in functional needs of the child.

The role of occupational therapist is to facilitate the independent functioning of infants and toddlers and their families. (Case-Smith, 1989)

Independent functioning of young children, according to their developmental age, is achieved through assessment and intervention effort in the areas of motor control, sensory modulation, adaptive coping, sensorimotor development, social-emotional development, daily living skills, and play. (Gorga, 1989)

Read More… Occupational Therapy for Children

Early Intervention and occupational therapy services-

In early intervention, occupational therapist plans out the initial assessment and set some objective and goals to achieve the desired outcome. After that,  the Occupational therapist applies intervention strategies.

Occupational therapy Evaluation and Assessment-

The process of evaluation is the gathering and interpreting of information on the child’s age, health status, medical history, current developmental level of functioning, family support to maximize the child’s development.

Who are eligible for the early intervention services?

The early diagnosis of a child helps him/her to get early intervention services. Diagnosis includes cerebral palsy, Down ’s syndrome, ADHD, Autism, spina bifida are generally needed early intervention. But not limited to this, a child with developmental delay may be because of any genetic, chromosomal problem, neurologic problem, trauma is also needed early intervention.

The occupational therapist evaluates many developmental areas of child and point out the problematic area. In general, OT assesses the motor component, sensory component, perception, cognition, communication, social, and emotional aspects of the child.

The therapist may use informal assessment through observing the child playing with parents. More specifically, occupational therapist can choose from a variety of standardized assessment kit for better screening. Some are-

• Bayley Scales of Infant Development
• Erhardt developmental prehension assessment
• The Hawaii Early Learning Profile(HELP);
• The Assessment, Evaluation and Programming System for Infants and Children, Second Ed. (AEPS);

The OT assessment should identify the child’s current abilities, strength, and areas of need to attain desired developmental outcomes. Here, we have mentioned some of the important assessment areas –

Assessment of motor components-

• Muscle tone
• Associated movements
• Balance and co-ordination
• Range of motion
• posture

Sensory Processing-

• Low sensory registration
• Sensation seeking
• Sensation avoiding
• Attention span

ADL-

• Feeding
• Dressing
• Toileting

Social

• Social smile
• Eye contact
• Play with others

Behavioral issues.

Goals and Objectives-

The occupational therapist on the early intervention team focuses on outcomes from a family-centered perspective. The goals should be focused on improvements in the gross motor skills and fine motor skills. The goals must be set after the discussion with the family member.

Occupational therapy Intervention-

Occupational therapists promote a child’s independence and self-confidence in their physical, emotional, and psychosocial development. Occupational therapy in early intervention is marked by engagement in meaningful occupations of the child and family in the natural environment.

Family centered approach –

In this approach, occupational therapist involves the family members in the intervention. The therapist guides the caretakers about the amount of involvement in child’s intervention program. Therapist can teach functional activities to the family members. Activities should be those that target behaviors and skills that the child can generalize to his or her daily routines at home, school, and community.

Activities should be those that target behaviors and skills that the child can generalize to his or her daily routines at home, school, and community. Therapist can provide support for families by listing to them, giving positive feedback regarding parenting skills.

Areas of Intervention-

Motor Area-

The motor skills are more prominent and attract first preference in the treatment planning. The gross motor skills, such as independent sitting, standing, and walking come under the first priority. Along with this, fine motor skills including grasp and release of objects, in-hand manipulation has its own importance.

Occupational therapist must be creative when designing intervention strategies with caregivers.

Sensory Processing –

Occupational therapist addresses therapy planning if there is anything related to sensory processing problem. The infant or toddlers may be irritable, cry frequently, be difficult to comfort, or have difficulty with changes in routine.

The therapist may use appropriate tactile, vestibular, and proprioceptive input that elicits organized behavior and adaptive responses in the child.

Occupational therapist promotes self-care in early intervention. Activities of daily living include feeding, dressing, toileting etc.

If self-care is restricted due to any motor or sensory issues, OT looks in that matter and guide the family member the right strategies. Many time modification of an environment is necessary for the adaptation. Assistive devices are also available, which help in feeding (modified spoon)

Play –

Occupational therapist assists in the refinement of the physical movement and mental abilities. Play is the perfect media OT uses to improve these areas. Play can be exploratory, creative, or competitive in nature. Therapist can teach a child gross motor and fine motor skills through play. The material (sand, plastic containers, spoons) typically found in the natural environment (home) should be the focus of play.

Adaptive Equipment-

Occupational therapist prescribes equipment that allows maximum function to the needs one. Custom made adaptive seating devices have been found to improve sitting postures and eating skills of young children with multiple handicaps. A variety of adjustable seating inserts, wheelchairs are available in the market. Therapist guides the parent which is the best option available for the particular child and helps them to train him.

Summary-

Occupational therapy is an integral part of early intervention team. Occupational therapists use holistic approaches with children and their main goal is to make them independent. Occupational therapy in early intervention program considers sensory, motor, social, and cognitive aspects of performance.

References-

Hopkins, Smith, Willard and Spackman’s Occupational Therapy, 8^th Ed. J.B. Lippincott company.

Jane Case-Smith, O’brien- occupational therapy for children 6^th Ed. Mosby.

Paula Kramer, Jim Hinojosa – Frames of reference for pediatric occupational therapy, 3^rd Ed. Lippincott Williams & Wilkins.