Specific Goals of Occupational Therapy Intervention
There are several specific areas in which OTRs provide therapy. They are discussed in the following section and include development of upper-extremity proximal stability, visual-perceptual, cognitive-adaptive, sensory integration, and self-care skills (Bundy, 1991). OTRs also help evaluate, design, and fabricate assistive equipment, determine appropriate seating and positioning, and evaluate the environment to determine the need for possible modifications (Frostig, 1974).
Upper-Extremity Proximal Stability
Upper-extremity proximal stability refers to the level of stability (firmness), ranging from children's trunk and shoulders (proximal) throughout the arms to the hands (distal). Proximal stability is believed to be the foundation on which hand skills may develop. Proximal stability assists children in sitting upright, which allows them to participate in tabletop activities (Frostig, 1974).
Because of the importance of proximal stability, the OTR often places children on various pieces of therapy equipment, such as bolsters or scooter boards, to enhance proximal stability. Working the trunk and upper body through exercises and activities is thought to promote improved proximal stability and distal hand skills (use of fingers for fine motor manipulation) for use in all areas of education and daily life (Larsen & Hammill, 1975).
Visual-Perceptual Motor Skills
Visual-perceptual motor skills are another area of emphasis in occupational therapy. These skills refer to children's physical responses to visual stimulation. Such skills are later used for activities such as reading from left to right or copying from the blackboard. During occupational therapy treatment, the OTR introduces activities that begin to challenge a child's visual-perceptual performance skills. Activities such as finding hidden pictures (figure/ground), bingo and lotto (visual scanning), concentration or memory card games (visual memory and matching), and block design replication (visual-spatial relations) address different aspects within the area of visual-perceptual motor skills.
Cognitive-adaptive skills are another area of focus in occupational therapy. These skills include a child's ability (cognitively, emotionally, and physically) to interact with others and adapt to different environmental situations such as going to a new classroom, adjusting to rearrangement of the classroom. and adjusting to new teachers.
OTRs work with family members and teaching staff to assess skills acquisition and formulate and present activities designed to enhance growth and development in this area. Some of the elements assessed in cognitive-adaptive skills include how children interact with peers and adults in one-to-one or group situations, whether they play or sit with peers or prefer to play alone, how they respond to reinforcement or discipline, and how well they can solve problems and adapt to new people and situations.
Another area of development an OTR addresses is sensory integration. Sensory integration involves a child's ability to incorporate sensory information into purposeful and successful interaction with the environment. Sensory information is interpreted by all the senses including touch (tactile system), sight (visual system), hearing (auditory system), smell (olfactory system), and balance or equilibrium (vestibular system) (Ayers, 1972).
Sensorimotor skills acquisition is based on a child's ability to integrate and process sensory information to elicit a physical response to the environment. Sensory integration and processing is a complex function of the nervous system. Imbalances or dysfunctions in any of these systems may result in sensory integration difficulties (Cherry, 1971). For instance, the impaired ability to visually scan the environment successfully or process tactile information correctly may result in a child lacking the ability to move about safely at home or school.
Children could have sensory integration difficulties for a variety of reasons. Children who have cerebral palsy, are classified as cognitively delayed, and are autistic frequently have sensory integration difficulties. Indicators of sensory integration difficulties include over or undersensitivity to movement or physical contact, abnormally high or low activity levels, difficulty learning new motor tasks, and delays in language acquisition or cognitive abilities (Ayers, 1972).
To enhance sensory processing, the OTR structures specific activities needed to address the areas of dysfunction. These activities expose children to sensory tasks they may choose to avoid. Sensory activities include playing in gelatin or with shaving cream and locating objects in rice at the sensory table. During these types of activities, children are not forced to participate but may be encouraged and assisted while attempting the task. Sensory integration enhances the nervous system in organizing and interpreting sensory input to enhance the effectiveness of motor output (Ayers, 1972).
In a therapy setting, the OTR might guide "scissor skills" development by helping children develop an appropriate grasp, which enhances eye-hand coordination. Other activities the OTR uses include blowing bubbles and encouraging children to pop them, playing with puzzles, stringing beads, and stacking blocks. These activities are also designed to enhance eye-hand coordination (Ayers, 1972).
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