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Specific Goals of Occupational Therapy Intervention (page 3)

By — Pearson Allyn Bacon Prentice Hall
Updated on Oct 25, 2010

Self-Care Skills

Another area of occupational therapy intervention is self-care skills, such as eating, getting dressed, using the toilet, and bathing. Occupational therapy deals with self-feeding, the hand-to-mouth action of eating. It also deals with eating, including chewing and swallowing, which involves functions and dysfunctions of the oral musculature (muscles). OTRs also focus on the relationship of the swallowing mechanisms to the various textures of food (Hotte, 1979).

Although OTRs often provide treatment in the areas of feeding, in many educational programs or clinics oral motor functioning is an area of specialization for speech and language pathologists. In this case, the OTR and speech and language pathologist address feeding dysfunctions as a team because self-feeding is an area of adaptation rather than remediation. The OTR often plays an active role in obtaining any adaptive equipment that is needed. For example, assistive equipment may include "built-up" utensils (thicker than normal) and spill-proof cups. The OTR focuses on proper positions that help children to function well while sitting. Appropriate positioning is crucial for promoting eating skills and helping to prevent choking. The OTR also provides recommendations about the types of foods that are safe for children to eat without choking.

If a child is experiencing feeding difficulties, the OTR working with the child offers suggestions regarding the mealtime experience based on the individual needs of the child. These recommendations are based on tests that have been completed, as well as clinical observations (Trombly, 1983). The child's OTR often provides a program of therapeutic techniques for the parents or caregivers to use at home. Table 10.4 provides a list of some eating difficulties children with motor impairment may exhibit and for which therapy may be effective (Stern & Gorga, 1990).

An OTR works with parents and staff to help a child develop other self-care skills. Children with disabilities frequently take longer to dress and undress. A therapist may suggest routines and help to establish a time to work on developing self-care skills. Dressing requires a great deal of muscle coordination. It also requires balance and control of muscle tension (Eastman & Safron, 1986). The OTR frequently provides guidance on how to help a child relax and best position a child before dressing the child or helping the child get dressed. The OTR might also provide suggestions about the type of clothing best suited for self-care (Pratt & Allen, 1989).

Eating Difficulties that May Be Helped by Therapy

  1. Diminished head and trunk control;
  2. Oral hyper- or hypo-sensitivity to stimulation'
  3. Jaw thrust—a strong protrusion of the lower jaw;
  4. Tongue thrust—forceful protrusion of the tongue when sucking, spoon- feeding, chewing, or drinking from a cup;
  5. Tonic bite reflex—a forceful closing of the jaw on stimulation to the teeth and gums (hypersensitivity);
  6. Lip retraction (called purse string)—extension of the lips into a tight horizontal line;
  7. Tongue retraction—a strong pulling back of the tongue into the throat (the pharynx), where it is held against the palate;
  8. Jaw retraction—the jaw is pulled back, preventing the alignment of the upper and lower teeth during feeding;
  9. Weak or inefficient sucking patterns.
  10. Poor lip closure—needed to remove food from a spoon;
  11. Poor tongue lateralization—the inability to move food adequately inside the mouth from side to side;
  12. Poor chewing technique;
  13. Excessive mucus or saliva secretions.
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