Occupational Therapy for Children

What is Occupational Therapy for Children –

Occupational therapy is a broad field and provides treatment to many patients from newborn to the elderly. An occupational therapy for children has a very important role in making kids independent in each area of life.

The typical human development is the knowledge base of pediatric occupational therapy. Early physical/mental development may have some issues or impairment, and children’s occupational therapist works on these areas to recover from the impairment.

Read More… what is Occupational therapy?   what do occupational therapists do?

Occupational therapy focuses on the “occupation” of a child. You may be puzzled that a newborn or a 6 year old child doesn’t have any occupation, but in OT point of view, every human being has an occupation. A child’s occupation would be play, exploration of an environment, and social interaction.

Disability or impairment restricts the child to involve in play and bring dependency on others. Other functions (mentioned above) would be less developed and create a problem in self-care.

A play is considered as a primary occupation of a child. Play helps the child to learn new skills, improve social/family interaction and develop other functions (e.g. motor, social, cognitive and self-care skills.)

Play activities are generally central to an occupational therapy session because these activities engage and motivate the child; elevate his/her focus and performance.

A play is a key area of occupational focus in practice with children. It also acts as a catalyst to the development of motor or cognitive skills.

Occupational therapy works with special children’s having disorder like Cerebral palsy, kids with Developmental Delay, Down’s Syndrome, Autism, ADHD, Learning Disability, Mental Retardation, and Sensory Processing Disorder. These are established diagnosis where therapist provides their service.

But along with these, OT provides treatment for children having orthopedic problems, neurological problems, genetic problems, social problems if they are having issues in daily life tasks and dependency on others.

Occupational therapy Assessment for children-

Pediatric occupational therapist evaluates children and their environment to gather information needed to make a decision about intervention planning.

Pediatric occupational Therapist assesses what the child wants and needs to do and identifying those factors that act as a support or a barrier to the child’s participation in daily life.

Initially, OT develops a profile of the child based on referral concerns, interview with caregivers/parents and the child. An assessment also includes the direct observation of the child performing self-care, play, and school related activities.

The observation and performance of some standardized and non-standardized test help the OT to analyze the occupational performance of the child. It includes physical, cognitive & psychosocial performance.

Evaluation of the child’s occupation consists of the child’s performance skills (e.g. Gross motor skills, fine motor skills, process skills), Performance patterns (habit, routine) and performance context (cultural, physical, social).

Occupational therapist for kids evaluates and observe some neuromotor functions, i.e. posture, co-ordination, gross motor, fine motor, muscle tone, range of motion, presence of primitive postural reflexes, oculomotor abilities (focus on an object, tracking object), upper and lower extremity strength and endurance. Along with these, perception and cognitive skills are also evaluated by OTs.

The occupational therapist also assesses children’s self-care, mobility, communication, social problems. For this OT may use the WeeFIM scale (functional independence measure for children)

Standardized Assessments-

Lots of standardized assessment kits/scales are available for pediatric assessment. It totally depends upon the therapist’s general observation and child’s disability to prefer the specific tests.

Purposes of standardized tests –

• Assistance with medical/ educational diagnosis.
• Documentation of developmental and functional status
• Planning of intervention programs

These are some examples of pediatric standardized tests –

• Peabody developmental motor scale (2^nd Ed.)
• Pediatric evaluation of disability inventory (PEDI)
• Sensory profile
• Assessment of motor and process skills (AMPS)

Occupational therapy intervention for children-

A child moves into and out of position fluidly and with ease, exploring their world, learning about their bodies and developing motor, cognitive, sensory and social skills.

Conversely, children with motor control deficit have difficulty in such activities and dependent on others for daily routine tasks. The Occupational therapist is concerned with how to help children control movements so that they may engage in their occupations.

Occupational therapy goals for children-

After the complete evaluation process, children’s occupational therapist set goals that are achievable and realistic.

Goal setting totally depends upon the problem areas. Every kid is different and his/her problem too. Like cerebral palsy or developmental delayed child has motor issues, while autistic or ADHD kids have sensory issues. These issues may vary.

Let’s see some of the examples of goals and objectives setting-

Example of OT goals for cerebral palsy kids-

• To manage muscle tone.
• To Improve coordination, balance, and hand function.
• To improve communication.
• To improve transition from one surface to others
• Independent seating, standing and walking.
• To improve play
• To improve ADL tasks.
• To improve handwriting skills.
• Potty training

Example of OT goals for Autism and ADHD kids-

•  To improve attention and seating tolerance.
•  To lessen sensory issues ( like tactile defensiveness)
•  To improve social interaction
•  Follow multiple commands

Occupational therapist for children manage these issues with different techniques and approaches. Here we have mentioned some of the problem areas and how occupational therapist deals with them.

Motor Control-

Motor control is defined as the “ability to regulate or direct the mechanisms essential to the movement.” OT intervention goals may include to –

•   Improve Abnormal muscle tone
•    Sensory dysfunction
•    Muscle weakness
•    Poor endurance

Many approaches may be used during intervention includes-

• Sensory Integration
• Neurodevelopmental therapy
• Strength training
• Perceptual motor training.

These interventions focus on decreasing the underlying deficit and improving performance.

These interventions help to improve postural control, balance, visual perception, and body awareness.

Sensory integration-

Sensory integration approach is based on the senses and its adaptive integration to make it effective.

When the children’s senses are not integrated, they may suffer from sensory processing disorder (SPD).

A pediatric occupational therapist uses different sensory strategies (such as joint compression, blanket wrap, and slow rocking) to manage the sensory issues (such as inattention, balancing, avoid touching, hyperactivity)

The therapist is seeking an adaptive response evoking motor behavior that supports effective interaction with the environment. A variety of equipment (such as scooter board, and bolster swing) used in sensory integration.

Read More…  Sensory Integration, sensory diet

Neurodevelopmental therapy (NDT)–

NDT provides a sound foundation for the treatment of cerebral palsy kids and hemiplegic child. NDT is based on the normal development and movement.

In NDT, the therapist develops a program which helps the child to avoid any abnormal patterns of movement because of abnormal muscle tone.

Pediatric occupational therapist prefers NDT to promote the highest level of functional recovery based on relearning normal movement, rather than on compensation.

The quality of movement, control, and coordination are emphasized by using treatment methods to normalize abnormal muscle tone and to avoid abnormal patterns of movement.

NDT treatment provided by therapist includes different techniques, some are-

• Weight-bearing over the affected side.
• Trunk rotation.
• Facilitation of slow and controlled movements.
• Proper positioning,
• Incorporating the upper extremity into functional activity.

Read More… Developmental Frame of Reference

OT intervention for hand skills-

Hand skills are critical and required to perform activities of daily living. The child with difficulty in hand function has less opportunities to experience the environment.

Hand skill doesn’t only depend on the hand musculature but it also depends upon the posture, cognition, and visual perception.

Hand skills are also sometimes called as fine motor skills.

OT provides visual motor integration it includes the interaction of visual skills, visual perceptual skills, and motor skills.

Hand skills include reach, grasp, carry and voluntary release, in-hand manipulation, and bilateral hand use.

OT provides therapy to improve hand function, it includes-

• Improvement in postural tone and control,
• Improvement in muscle strength,
• Improvement in isolated arm and hand movement,
• Use of splint and adaptive devices.

Improve social participation –

The promotion of child’s social participation within the family, with friends, classmates, caregivers are an essential domain of occupational therapy. OT helps to improve the social participation through individual and group therapy program development, and consultation.

Challenging behavior –

Children with a variety of disabilities may display challenging or inappropriate behavior that interferes with daily life activities. Behavior management strategies designed to prevent and reduce challenging behavior are an important component of an OT intervention.

Role of OT in the management of challenging behavior is to –

• prevent challenging behavior from occurring.
• supporting desired behavior
• intervening when challenging behavior already exists.

Prevention techniques can be taught to parents/caretaker, some are-

• Minimize aversive events
• Providing an environment that promotes successful engagement.
• Support self-regulation

Support desired behavior – strategies for supporting positive behavior can be powerful tools in preventing situation that elicit problem behavior.

• Meeting sensory needs
• Building new skills.
• Positive reinforcement.

Feeding Intervention –

Some kids are undernourished due to lack of proper dietary habit. It may be because of developmental or sensory issues. But it is required for normal growth and development. The OT has sound knowledge of basic anatomy and physiology of oral structure.

An OT can help improving in sucking, drinking, biting, and chewing.

The OT may use different techniques to improve feeding, some techniques are-

Environmental adaptations, positioning adaptations, intervention for sensory problems, adaptive equipment, modification of food and liquid properties.

Activities of daily living-

Activities of daily living hamper as a child doesn’t get involved in self-care. The reasons may vary and may be due to motor control delay or sensory issues. As the ADL tasks are the locus of OT treatment. OT train kids in toilet training, hygiene training, one to one training in dressing, assistive technology, and environmental modification.

Play –

A play has always been a part of pediatric occupational therapist’s treatment approach. And a play is the primary occupation of a child. Play helps to learn a new skill or master the old skills. Play is the part of the developmental frame of reference and sensory integration approach. OT uses play as a modality in intervention planning.

Prewriting and handwriting skills-

In the areas of education, school-aged children’s occupations encompass academic skills such as reading and writing. Writing skill is required when children compose stories, written examination, etc. writing is a complex process requiring both motor and cognitive functions.

The Occupational therapist understands the problem and may use remedial or compensatory approach to solve the issues of handwriting. The OT uses some techniques to improve the –

•  sitting posture,
• pencil gripping pattern,
• perception,
• visual motor integration, and
• eye-hand coordination.

Where does a pediatric OT provide services for children-

The pediatric occupational therapist works with children in NICU, Early Intervention center, schools, hospital pediatric rehab center, and a private clinic.

Summary –

Occupational therapy is an integral part of children’s rehabilitation. Occupational therapist deals with special kids and tries to make them independent. the therapist uses different approaches to help these special kids.

References –

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.

Lynn Horowitz, Cecile Rost – Helping hyperactive kids- A sensory integration approach. 1^st ed. Hunter house publication