This case study describes an OT intervention for a student named Alan with global developmental delays. The OT used a client-centered approach including occupational profiling, assessment, goal setting, and monitoring to address Alan's difficulties with handwriting, attention, and social participation in school. Sensory-based interventions were implemented weekly and found to improve Alan's classroom attention and social interactions. His handwriting also noticeably improved. The OT collaborated with Alan, his teacher, and mother throughout the process.

1. Student: Colin Jones Date: 16/10/14
Supervisors: Joelle O’Connell & Cathy Wyer
Using the OT Process to Promote
Functional Performance in School

2. Introducing Alan:

3. Objectives of Case-Study:
1. Demonstrate how the OT Process is
applied to a client presenting with Global
Developmental Delay.
2. Discuss use of clinical reasoning skills
throughout the process.
3. Describe how the client’s function in
the school environment was promoted from an
OT perspective.

4. The OT Process
• Townsend et
al (2011)
Referral
Occupational
Profile
Assessment Goal Setting
Intervention
Plan
Intervention
Monitor &
Modify
Evaluate
Outcome
Conclude

5. Referral
Referral from teacher outlined areas
requiring support:
 Handwriting – Needs support. Writing not on
the line.
 Fine Motor Strength – Difficulty using
Theraputty.
 Balance – Wobbly at times.
 Attention Span – Distracted at times and
not appropriately engaged in class
activities.

6. Occupational Profile
Person:
 Youngest in family of 5 boys, 3
girls. Twin.
 Enjoys singing, drama, Star Wars,
Lego Ninjaga, swimming, Minecraft.
 Plays during yard, one good
friend. Works alone in class.
 Global Developmental Delay:
Disturbance in a child across
one or more developmental
domains, which include motor,
cognition, daily activities,
speech and language (Patil et al,
2014).
Person
Environment
Occupation
Environment:
 School environment
 Social environment
Occupation:
 Education
 Social Participation
 Play
OCCUPATIONAL PERFORMANCE
• Law et al (1996)
• Patil et al (2014)

7. Assessment

8. Occupational Performance Issues:
1. Demonstrates anxiety at times,
especially in new situations. Usually
requires graded introductions to new
classes.
2. Reported to have difficulty engaging in
social situations and challenges with
transitions between classes.
3. Handwriting - poor letter formation is
affecting progress in class.

9. Goal-Setting
2.Sensory-Based Intervention
• Long-term: Improve ability
to self-regulate and
function in classroom
environment.
• Provide sensory input
(proprioceptive and
vestibular) for Alan
during weekly OT session.
• 4 Week Goal: Improve
ability to attend to tasks
in class (Feedback with
teacher).
1.Handwriting Without Tears
• Long-term: Improve
handwriting ability in
class.
• Work on fine motor
function and letter
formation using multi-
sensory approach.
• 4 Week Goal: Reproduce
Frog Jump Capitals F, E, D
and P independently in
class.

10. Sensory-Based Interventions
Sensory Integration Framework
• Includes perception, modulation, and integration of
sensory information as a foundation for participation in
activities across social, physical, learning and daily
living tasks (Ayres, 1972).
Sensory-Based Interventions
• Sensory-based interventions applied in the school
environment may not have any benefit (Case-Smith et al,
2014).
• No effects from multi-sensory stimulation (Devlin et al,
2009, 2011, cited in Case-Smith et al, 2014).
• Fazlioglu & Baran (2008), cited in Case-Smith et al
(2014), found strong effects in reducing sensory problems.
No double blind testing or fidelity measures.

11. Intervention Plan
1.Handwriting Without Tears
• 4 Week Goal: Reproduce
Frog Jump Capitals F, E, D
and P independently in
class.
• Weekly session with
student OT focusing on
Frog Jump Capitals.
• Feedback with teacher to
confirm skills are
transferred.
2.Sensory-Based Intervention
• 4 Week Goal: Improve
ability to attend to tasks
in class (Feedback with
teacher).
• Weekly session with OT and
student OT focusing on
activities that provide
proprioceptive and
vestibular feedback.
• Feedback with teacher to
confirm if attention to
class activities and
social interactions
improve.

12. Intervention

13. Monitor/Modify
Aim to design a “just right” challenge for Alan
Zone of optimal engagement
• Anzalone & Ritchey
(2013)

14. Evaluate Outcome
 Evaluate progress after four week block. Feedback with
teacher, SNA and Mum.
 Handwriting: Reported to have improved noticeably in
class.
 Improved ability to attend to task in class following
movement-based sensory sessions with SNA in morning.
Reported to have increased social interactions on bus
following OT sessions.
 Both sensory-based interventions appear effective at this
stage.

15. Conclude
 Handover of Handwriting programme to SNA. Debrief with
Mum, teacher and provision of intervention summary and
strategies sheet for all parties.
 OT and SNA to continue to progress with sensory-based
sessions.

16. Questions

17. References
 Anzalone, M. E., & Ritchey, M. (2013). Developmental and Dyadic
Implications of Challenges With Sensory Processing, Physical
Functioning, and Sensory-Based Self-Regulation. Infant and Early
Childhood Mental Health: Core Concepts and Clinical Practice, 209.
 Ayres, A. J. (1972). Improving Academic Scores through Sensory
Integration. Journal of Learning Disabilities, 5(6), 338-343.
 Case-Smith, J., Weaver, L. L., & Fristad, M. A. (2014). A
systematic review of sensory processing interventions for children
with autism spectrum disorders. Autism, 1362361313517762.
 Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts,
L. (1996). The person-environment-occupation model: A transactive
approach to occupational performance. Canadian Journal of
Occupational Therapy, 63(1), 9-23.
 Patil, R. B., Urs, P., Kiran, S., & Bargale, S. D. (2014). Global
developmental delay with sodium valproate-induced gingival
hyperplasia. BMJ case reports, 2014, bcr2013200672.
 Townsend, E. A., Polatajko, H. J., Craik, J. M., & von Zweck, C.
M. (2011). Introducing the leadership in enabling occupation (LEO)
model. Canadian Journal of Occupational Therapy, 78(4), 255-259.