Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Occupational therapy in school settings.1.16.2012.rev

Hello, Attached is my PowerPoint presentation created for the AIOTA conference! Any questions please e-mail!

  • Login to see the comments

Occupational therapy in school settings.1.16.2012.rev

  1. 1. Presenter: Amy Carroll, OTR/L LEAP Occupational Therapy OTICON 2012, Goa, India 16 January 2012
  2. 2. About Amy Carroll  OTR/L  NBCOT  25+ years experience working in public schools (government schools)  20+ years experience as private practitioner  Advanced training in Sensory Integration & Interactive Metronome  O.T. Doctorate student at Thomas Jefferson University in Philadelphia, U.S.
  3. 3. Presentation Overview Occupational Therapy in School Settings  Guidelines for my practice (AOTA & U.S. Law)  O.T. Role in U.S. Schools  OT Process in schools Intervention for Children with Learning Disabilities  Evaluations  Common Issues  Specific Intervention Activities & Tools
  4. 4. Guides to my practice
  5. 5. AOTA Practice Framework: O.T. Domain Occupation Environment Performance & Context Skills O.T. DOMAIN Activity Performance Demands Patterns Client Factors Adapted from: American Occupational Therapy Association, 2008
  6. 6. Guide to Practice:U.S. Law Related to Special Ed. and School-Based O.T. Individuals with Disabilities Education Education Act for the Handicapped 1990:s Act 1980s: 2004 1970s 1960s OT: a “related service” within special education Source: Pape & Ryba, 2004
  7. 7. : General structures for service Clinical vs. School-Based Clinical: Schools (treat, remediate) (access, benefit, participate) In clinic, hospital, private • In school: classroom, practice gym, cafeteria, etc. Sensory Integration (SI) • Sensory Regulation Neuro-developmental • Principles of NDT treatment (NDT) • Develop. Activities Listening Programs • Practical tools and techniques • Assistive technology
  8. 8. Response to Intervention: 3 Tiers
  9. 9. U.S. School-Based O.T. ProcessReferral Evaluation Team Re- Meeting Evaluation Discharge Monitor Individual & Education Plan Report (IEP) Intervention
  10. 10. Tools & Techniques
  11. 11. U.S. School-Based O.T. ProcessReferral Evaluation Team Re- Meeting Evaluation Discharge Monitor Individual & Education Plan Report (IEP) Intervention
  12. 12. Students with Learning Disabilities:Common Areas of Concern for Referrals• Handwriting• Work completion• Fine-motor skills• Lack of Self-Regulation• Poor Attention• Behavior Management Issues• Disorganization• Social Skills and social participation• Academic Issues (reading, math, etc.)• Transitions from school to the work world
  13. 13. Students with Learning Disabilities:Evaluation Process Understand referral  Discuss with teachers, parents, or school psychologist Gather relevant background information Observe child in various natural school settings Consider potential problem and root cause Administer assessment tools
  14. 14. Students with Learning Disabilities:Primary Assessment Tools (1 of 3) Occupational Profiles/ Inventories:  Canadian Occupational Performance Measure  School Function Assessment Handwriting Assessment  Evaluation Tool of Children’s Handwriting  The Print Tool  WOLD Sentence Copying Test
  15. 15. Students with Learning Disabilities:Primary Assessment Tools (2 of 3)  Visual Perception  Motor-Free Visual Perception Test 3  Test of Visual Perceptual Skills, Revised  Visual Motor/Visual Perception  Beery VMI 5th edition  The Developmental Test of Visual Perception 2
  16. 16. Students with Learning Disabilities: Primary Assessment Tools (3 of 3)• Fine Motor / Visual Motor • Bruininks- Oseretsky Test of Motor Proficiency 2 • PDMS-2: Peabody Developmental Motor Scales, Second Edition• Sensory Processing / Sensory Modulation • Sensory Profile • Sensory Profile School Companion • Adolescent/Adult Sensory Profile • Sensory Processing Measure
  17. 17. The Student’s Educational Team Parents Therapist(s) TeachersStudent Para-Educators Administrator
  18. 18. Students with L.D.:Common Issues Requiring Intervention  Stability and motor control  posture, shoulder, wrist, grasp  Bilateral integration  Visual skills  Sensory regulation/modulation  Praxis  Organization
  19. 19. Stability and Control: Posture  Stable posture is important for desk work 90 – 90 SITTING POSTURE Hips: 90° Knees: 90° Ankles: 90°
  20. 20. Posture Intervention: Key ConceptsDo seatwork after ―heavy work‖ (gym, playground, etc.) and movement experiencesWork for brief periods, and in different positions • Sit at desk, bean bag chair, on a therapy ball • Standing at the blackboard or an easel • Prone with pillow under chest • short periods initially (i.e. 5 min)
  21. 21. Posture Intervention: Activities Lazy 8’s Scooter Prone over a ball Mini- Trampoline Parachute
  22. 22. Posture Intervention: Common Tools Desk top slant boards  Recommended slant = 20°  3-inch binder is an inexpensive substitute Move-n-Sit / Wedge Cushion  Encourages upright sitting posture  Allows for subtle movement Therapy ball
  23. 23. Stability and Control: Shoulder Shoulder stability is needed for fine-motor control Signs of decreased shoulder stability:  Shoulder hiking  Scapula winging  Arms and wrists not grounded when writing
  24. 24. Shoulder Intervention Key Concepts  Same as many postural intervention activities  Use activities requiring heavy work in the shoulder area  Animal walks, wheelbarrow walking, etc.  Chair pushups  Prone on elbows (lying on stomach)  Writing on the chalkboard –vertical surface Common Tools  Slant board  Desktop easel
  25. 25. Stability and Control: Wrist  Wrist should be in slightly extended or neutral position  Good wrist position supports mature grasp  Stable wrist position necessary for speed & precision  Flexed wrist position is not functional (Benbow, 2000)
  26. 26. Wrist Intervention: Key Concepts Use vertical work surfaces  chalkboard or easels  Slant board Lean forearm and wrist against the blackboard Keep activity at the child’s eye level Paper position affects wrist position  Paper parallel (~ 30° angle) to the writing forearms natural position  Beginner printers can start with the paper on a horizontal plane (Sources: Pape &Ryba, 2004 and Olsen, 1994)
  27. 27. Wrist Intervention: Common Tools 6-inch piece of masking tape slanted 30°  For consistency and spatial organization Slant Board  Encourages proper wrist position
  28. 28. Stability and Control: Hand (Grasp)  Typical children use static or dynamic tripod or quadripod grasp by age 5 Mature Tripod Quadripod  By age 6 or 7, most children can write or draw using the intrinsic muscle movements of the fingers  Hands stabilized to allow refined finger movement, rather than wrist / arm movements
  29. 29. Common Incorrect Grasps Tower Thumb Wrap Index tucked, Trap Grasp Grips Trap Grasp Fisted Grasp Extended Finger Grasp Extended Finger, Ungrounded Forearm
  30. 30. Grasp Intervention: Key Concepts  Look for the open circle web space to quickly identify the quality of a grasp  Allow preschool children to explore  Different patterns of grasping  Different drawing & writing tools  Encourage achievement of milestones to develop hand  Arches  Wrist extension  Skilled vs. stable sides of hand (A-OK grasp)  Finger muscle movement (Case-Smith & Pehoski, 1992; Benbow 2000; Olsen, 2003)
  31. 31. Grasp Intervention: Training Activities Pegs Coin Activities Color-forms Kitchen GadgetsTweezers Putty Coins
  32. 32. Grasp Intervention: Grip Pressure Focus on:  Stability and control more proximally  Fine motor control and quality of the grip Intervention Activities:  Open non-dominant hand on the desk  Squeeze a ball in non-dominant hand  Line-up dominoes  Pick-up fragile objects with fingers or tweezers  Drop a specific number of drops from an eyedropper (Case-Smith & Pehoski, 1992; Benbow 2000; Olsen, 2003)
  33. 33. Grasp Intervention: Gripper Tools Stetro Grip The Pencil Grip ThePencil Grip Handiwriter Handiwriter
  34. 34. Bilateral Integration: Dominance • Most children have dominance before school age • If no dominance in preschool or kindergarten: • Hold a bit on pencil paper tasks • Observe to see a pattern emerging • If no preference emerges by age 7, some specialists suggest encouraging right hand dominance (most common). I have always allowed the dominance to emerge. • If dominance issues exist, the teacher should expect the child to be less skilled for a time ( Benbow 2000; Olsen, 2003)
  35. 35. Bilateral Integration: Helping Hand Non-Dominant hand = helping hand Helping hand- essential for many school activities especially proper handwriting  Stabilizes the paper  An open helping hand often promotes a more relaxed grasp (Olsen, 1994)
  36. 36. Bilateral Integration: Common Tools Googly-Eyes Googly - Eyes Dino-Ruler Clipboard Bow-Tie Board
  37. 37. Bilateral Integration: Activities Handwriting Coin Flips Geo-Board Etch-a-Sketch Toy Putty Specialized Games
  38. 38. Bilateral Integration: Activities Jump Rope Lazy-Eights Parachute Mini-Tramp Crazy Clock Scooter Suspended Ball
  39. 39. 4 Key Aspects of Vision• Acuity (addressed by Dr.)• Ocular- Motor• Visual- Perception• Visual-Motor Integration  Note on Visual-Motor Integration:  Diagonal lines develop later than vertical and horizontal  Developmental sequence for design copying: l — 0 + / 
  40. 40. Visual Intervention: Techniques  Remove clutter to eliminate competing visual stimuli  Highlight writing baseline, or important part of a ditto  Reversals:  Gray block paper or rectangle  Letter formation patterns  Spacing between letters:  Exaggerate space between words  The big nothing  Finger in the space (often difficult)  Encourage consistent letter formation habits (Some ideas from Olsen, 1994)
  41. 41. Visual Intervention: Techniques  Vertical and horizontal skills develop earlier than diagonal skills  Sometimes children do better when they learn cursive  continuous movement  more developed foundation skills  fresh start Visual skills develop through movement
  42. 42. Visual Intervention: Activities •Visual skills develop in concert with movement
  43. 43. Visual Motor Intervention:Chalkboard Activities Circle Drawings Square Drawings
  44. 44. Visual Motor Intervention:Chalkboard Activities Tangle Roller Coaster Paint the Fence Bubble Gum Machine (Adapted from Chalkboard Fun, Sena, 1996)
  45. 45. Visual Motor Intervention: ChalkboardActivities Train Tracks Fire-fighters Wallpaper (Adapted from Chalkboard Fun, Sena, 1996)
  46. 46. Visual Motor Intervention: Activities Sign-In Activity (Olsen, 2003)
  47. 47. Visual Intervention: Tools  Vertical Surfaces 2 lined paper  Slant boards  Adapted Paper  Highlighted Ruler Stop-Go Paper “Best” Cue Card Shaded PaperBEST!B- Bump the baseline Highlight RulerE- Easy to read lettersS- SpacingT- Tall letters tall… small letters small !- Punctuation! (Carroll, 2003)
  48. 48. Sensory Regulation / Modulation States of Alertness / States of Arousal  Too High, Too Low, or Just Right  ―Just Right‖ = settled and focused for learning Sensory regulation strategies = ―Sensory Diet‖ Many times less stimulation is needed  Allow quiet time-maybe a book or music in a bean bag  Cubby or cave with comforting items Also Important to consider:  Establish routines  Warn of changes in routine (Williams & Shellenberger, 1996)
  49. 49. Sensory Regulation Strategies & Tools Sensory regulation strategies = “Sensory Diet”  ―As needed‖ or at scheduled times  Older children learn when and how to use strategies  Heavy Work (see posture activities)  Pushing & pulling activities  Jumping & hopscotch, animal walks, obstacle course  Squeezing foam ball , putty, clay  Thumb-Wrestling  ―Spiders on a mirror‖ / resistive toys  Deep Pressure  Compression clothing / lycra clothing  Hot dog, massage, brushing
  50. 50. Sensory Regulation Strategies & Tools  Heavy Oral Activities  Sucking or mints or sour hard candy.  Chewy candy (licorice, gummy bears), dried fruit, gum  Sipping from water bottles.  Movement / Physical Activities  Swings and scooter board, obstacle course  Move’n Sit cushions  Varying positions  Sitting on a ball or small rocker  ―Fidget‖ tools (plastic coils, squeeze balls, silly putty)
  51. 51. Sensory Regulation: Common Tools Lap Buddy Theraband on ChairTennis Balls on Chair Rocker Body Sock Chair Crash Pad Move-n-Sit Cushion Bean Bag Break Area
  52. 52. Praxis: Key Concepts Praxis = The ability to plan and execute new or novel motor sequences Children with poor praxis commonly display:  Difficulty establishing routines  Difficulty with self care tasks (open locker combination, managing belongings)  Labored handwriting  Difficulty or reluctance in gym and recess  Requires more time to complete tasks  Can be resistant to new activities
  53. 53. Praxis: Interventions Tactile and Proprioceptive activities (heavy work)  Obstacle courses  Play on playground equipment  Scooter board activities  Working with clay or putty, resistive mediums Multi-step projects  Crafts  Constructional toys (Legos etc.)
  54. 54. Praxis: Tools & Techniques Break down instruction into steps Repeat directions and provide additional visual cues Demonstrate Desk Map Teach student to ―self talk‖ through a task Checklists for routines Social stories for routines Multisensory handwriting instruction for stroke sequences Consider early keyboarding Practice self care fasteners Lunch packages: parents can cut small hole to help child open Pre-teach gross motor activities (input from Pape & Ryba, 2004)
  55. 55. Organization: Intervention Establish routines for where items are stored Provide sensory cues for transitions - visual, tactile, sound Teach transition cycle: Plan Set-up Clean- Do up (Carroll, 2003)
  56. 56. Organization: Common Tools Color coded folders or labels Accordion Files Copy lid in desk drawer Trapper keepers Allow an extra space to store items Locker : organize books into a.m. and p.m. Desk Map: diagram of where things go Map of where classrooms are-color coded Consistent format with class work
  57. 57. QUESTIONS?
  58. 58. References (1 of 4)  American Occupational Therapy Association. (2008). FAQ-Response-To- Intervention. Retrieved 12 13, 2011, from AOTA: chool/Copy%20of%20FAQ-Response-to-Intervention.aspx?FT=.pdf  American Occupational Therapy Association. (2011). Occupational Therapy in early Childhood and School-Based Settings. Retrieved December 20, 2011, from AOTA: American Occupational Therapy Association: s/40881.aspx?FT=.pdf  American Occupational Therapy Association. (2010). Occupational Therapy in School Settings. Retrieved January 2, 2012, from AOTA: The American Occupational Therapy Association: Sheets-on-the-Role-of-OT/School.aspx?FT=.pdf
  59. 59. References (2 of 4) American Occupational Therapy Association. (2008). Occupational therapy practice framework: Domain and process (2nd ed.). American Journal of Occupational Therapy , 62, 625-683. Amundson, S. J. (1995). Evaluation Tool of Childrens Handwriting: ETCH examiners manual. Homer, Alaska: O.T. Kids. Ayres, A. J. (1988). Sensory integration and praxis tests. Los Angelos: Western Psychological Services. Beery, K. E., & Beery, N. A. (2004). Beery VMI administration, scoring, and teaching manual (5th ed.). Minneapolis: NCS Pearson, Inc. Brown, C. E., & Dunn, W. (2002). Adolescent/Adult Sensory Profile: Users manual. San Antonio: Pearson. Bruininks, R. H. (2005). Bruininks-Oseretsky Test of Motor Proficiency (2nd ed.). Circle Pines, MN: AGS Publishing. Case-Smith, J., & Pehoski, C. (1992). Development of hand skills in children. Rockville: AOTA. Colarusso, R. P., & D., H. D. (2003). Motor-Free Visual Perception Test (3rd ed.). Novato, CA: Academic Therapy Publications. Coster, W., Deeney, T. H., & Haley, S. (1998). School Function Assessment. San Antonio : The Psychological Corporation.
  60. 60. References: (3 of 4) Dunn, W. (1999). Sensory Profile. U.S.: The Psychological Corporation. Dunn, W. (2006). Sensory Profile School Companion: Users manual. USA: PsychCorp. Fewell, M. R. Peabody Developmental Motor Scales (2nd Edition). Gardner, M. F. (1996). Test of Visual-Perceptual Skills (n-m) Revised manual. Hydesville, CA: Psychological and Educational Publications. Hammill, D. D., Pearson, N. A., & Voress, J. K. (1993). Developmental Test of Visual Perception, second edition. Austin: pro-ed. Kuhaneck, H. M., Henry, D. A., & Gleenon, T. J. (2007). Sensory processing measure. Los Angeles: Western Psychological Services. Law, M., Baptiste, S., Carswell, A., McColl, M. A., Polatajkp, H., & Pollock, N. (1994). Canadian Occupational Performance Measure (second ed.). Toronto: CAOT. Olsen, J. Z. (1994). Handwriting Without Tears, workshop Olsen, J. Z. (2003). Pre-K teachers guide. Cabin John, MD.: Handwriting Without Tears, Jan Z. Olsen.
  61. 61. References:(4 of 4) Olsen, J. Z. (2009). The Printing Tool. MD.: Handwriting without tears, Jan Z. Olsen. Pape, L., & Ryba, K. (2004). Roles of occupational therapy in the school setting. In L. Pape, & K. Ryba, Practical considerations for school-based occupational therapists (pp. 1-30). Bethesda: American Occupational Therapy Association, Inc. Reynolds, C. R., Pearson, N. A., & Voress, J. K. (2002). DTVP-A Developmental Test of Visual Perception: Adolescent and Adult examiners manual. Austin: pro-ed. Richards, R. M. (1988). Classroom visual activities. Novato, CA: Academic Therapy Publications. Sena, L. (1996). Chalk-Board fun. Bisbee, AZ: Imaginart Press. Williams, M. S., & Shellenberger, S. (1996). How does your engine run?: A leaders guide to the alert program for self regulation. Albuquerque: TherapyWorks, Inc. Wold, R. (1970). Screening tests to be used by the classroom teacher. Novato, CA: Academic Therapy Publications.