Definition of Occupational Therapy
Occupational Therapists use scientifically chosen meaningful activities to assist diverse clients with a range of problems to maximise their functioning. This empowers them to be as independent as possible and to experience dignity and quality of life at work, at home and at play.
Children are referred to Occupational Therapy, mainly for the following reasons : Gross and Fine motor difficulty (including handwriting difficulties), visual perception difficulties, poor attention and concentration, behaviour difficulties, as well as feeding difficulties or sleep difficulties which have underlying sensory processing difficulties. Babies are referred for sleep and feeding difficulties, developmental delay, including late achievement of all developmental milestones including delayed speech, delayed social development and poor behaviour.
Gross and Fine Motor Coordination difficulties
These difficulties are often on account of lowered muscle tone, which results in poor postural control.
We need good trunk stability or core stability, as well as good shoulder muscle strength and stability, in order to allow for adequate fine motor development. (Think of a crane….). The foundation for good postural control is usually laid down in the first year of life. The baby who does not enjoy being on his tummy unlikely to develop appropriate trunk control and shoulder control…. This might be on account of lowered muscle tone or a movement issue, or it may be on account of sensory processing difficulties. One often sees the beginnings of sensory processing and coordination difficulties in babies…… Midline crossing involves using the hand in the opposite body space. The child who has lowered muscle tone and weak trunk control is likely to M-Sit in an effort to avoid using his weak trunk muscles, – this contributes to further difficulties as he is not likely to develop good trunk rotation. The child who does not develop good rotation patterns is not likely to cross his body midline comfortably.
Sensory processing difficulties often result in poor ability in planning and sequencing movements. The clumsy child, might have reasonable muscle tone, and reasonable postural control, and yet he may have huge difficulty in getting his body to perform more complex sequences of movement. This child might have difficulty in learning new tasks, and might be rather slow in executing most tasks. If he is given the opportunity to practice tasks, he may be able to master them well, but the moment the task is changed slightly, he suddenly has difficulty working out how to compensate for the change. For example, he might be comfortable with throwing and catching a regular sized ball, but the moment the ball size or weight changes, he becomes anxious and uncertain as he does not know how to generalise the components of the movements to the changed situation. This clumsiness, or dyspraxia, often results in serious emotional difficulty for the child, as he always feels inadequate, and uncertain about his ability to act on his world. This difficulty can arise on account of a difficulty in imagining or visualising one’s body moving or executing the movement., or it could be on account of difficulty in anticipating timing and sequencing of the movements. The child is likely to have poor feedback from his body about how he executed the movement. He therefore struggles to work out how to correct his performance and to improve upon his performance when he repeats the actions. We are seeing far more children who have difficulty with planning and with problem solving……
Attention and Concentration Difficulties or Behaviour Difficulties. These difficulties often occur on account of poor sensory processing ability.
The child might be hypersensitive to touch, or tactile defensive, and may find it very difficult to pay attention in an environment where he is exposed to much inadvertent touch input.
He might be hypersensitive to sounds, and might find it very difficult to cope with a high noise level in the classroom.
The child who has a Vestibular processing difficulty may have a higher than usual need for movement. The manner in which his vestibular system processes movement input is unusual and this child might have a high threshold for movement input so that he never sits still. If this tendency is coupled with lowered muscle tone, the child would be inclined to be restless and fidgety simply on account of trying to raise his muscle tone and to relieve tiring muscles.
The child who has sensory processing difficulties may find it very difficult to regulate his “arousal” level, so that he tends to be overexcited in situations where he should be calm and quiet.
Children who present with sensory modulation and sensory regulation difficulties often behave inappropriately and may be disruptive in the classroom.
We would offer organising sensory and movement input to assist the child in normalising his reaction to sensory input. The approaches used might include tactile brushing, the use of balls or inflatable cushions in the classroom, deep pressure or heavy resisted activities, the use of weighted waistcoats or weighted lap blankets or sensory fidgets in the classroom. The “sensory diet” needs of each child would be different. An OT experienced in sensory integration could assess the need and offer appropriate therapy.
The child whose autonomic nervous system is primarily in survival mode, might also have dietary issues which need to be considered. We work closely with dieticians to ensure that the child’s blood sugar levels are stable, and that the child is eating a healthy balanced diet with all the necessary minerals vitamins etc.
We work closely with Physiotherapists and we will often see a child briefly, to address sensory regulation or sensory integration difficulties, and then refer them for physiotherapy to address their postural control difficulties. We often find that the child’s fine motor ability improves because you have dealt with the foundation issues in physiotherapy. The child might then come back to OT, and the remaining fine motor or perceptual difficulties are dealt with far more speedily as the child has improved postural control and core stabiliy.
Core stability and good sensory integration are central to good emotional, social and academic development.