Amy Carroll presents on occupational therapy in school settings, highlighting guidelines, the role of occupational therapists, and intervention strategies for children with learning disabilities. The document outlines assessment tools, intervention techniques, and common issues faced by students, emphasizing the importance of posture, motor skills, and sensory integration. Additionally, it offers practical tools and strategies for improving student outcomes through effective occupational therapy practices.

1. Presenter: Amy Carroll, OTR/L
LEAP Occupational Therapy
Carroll.amyp@gmail.com
OTICON 2012, Goa, India
16 January 2012

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. 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. Guides to my practice

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. 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. :
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. Response to Intervention: 3 Tiers

9. U.S. School-Based O.T. Process
Referral Evaluation
Team
Re- Meeting
Evaluation
Discharge
Monitor Individual
& Education Plan
Report (IEP)
Intervention

10. Tools & Techniques

11. U.S. School-Based O.T. Process
Referral Evaluation
Team
Re- Meeting
Evaluation
Discharge
Monitor Individual
& Education Plan
Report (IEP)
Intervention

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. 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. 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. 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. 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. The Student’s Educational Team
Parents Therapist(s)
Teachers
Student
Para-Educators
Administrator

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. Stability and Control: Posture
 Stable posture is important for desk work
90 – 90 SITTING
POSTURE
Hips: 90°
Knees: 90°
Ankles: 90°

20. Posture Intervention: Key Concepts
Do seatwork after ―heavy work‖ (gym, playground,
etc.) and movement experiences
Work 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. Posture Intervention: Activities
Lazy 8’s
Scooter
Prone over a ball Mini-
Trampoline
Parachute

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. 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. 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. 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. 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 forearm's
natural position
 Beginner printers can start with the paper on a
horizontal plane
(Sources: Pape &Ryba, 2004 and Olsen, 1994)

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. 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. Common Incorrect Grasps
Tower
Thumb Wrap Index tucked, Trap Grasp
Grips
Trap Grasp
Fisted Grasp Extended Finger Grasp
Extended
Finger,
Ungrounded
Forearm

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. Grasp Intervention: Training Activities
Pegs Coin Activities Color-forms
Kitchen Gadgets
Tweezers
Putty
Coins

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. Grasp Intervention: Gripper Tools
Stetro Grip The Pencil Grip
The
Pencil
Grip
Handiwriter Handiwriter

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. 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. Bilateral Integration: Common Tools
Googly-Eyes Googly - Eyes
Dino-Ruler
Clipboard Bow-Tie Board

37. Bilateral Integration: Activities
Handwriting
Coin Flips
Geo-Board
Etch-a-Sketch Toy
Putty
Specialized Games

38. Bilateral Integration: Activities
Jump
Rope
Lazy-Eights Parachute
Mini-
Tramp
Crazy Clock
Scooter
Suspended Ball

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. 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. 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. Visual Intervention: Activities
•Visual skills develop in concert with movement

43. Visual Motor Intervention:
Chalkboard Activities
Circle Drawings Square Drawings

44. Visual Motor Intervention:
Chalkboard Activities
Tangle Roller Coaster
Paint the Fence
Bubble Gum Machine (Adapted from Chalkboard Fun, Sena, 1996)

45. Visual Motor Intervention: Chalkboard
Activities
Train Tracks Fire-fighters
Wallpaper
(Adapted from Chalkboard Fun, Sena, 1996)

46. Visual Motor Intervention: Activities
Sign-In Activity
(Olsen, 2003)

47. Visual Intervention: Tools
 Vertical Surfaces
2 lined paper
 Slant boards
 Adapted Paper
 Highlighted Ruler Stop-Go Paper
“Best” Cue Card Shaded Paper
BEST!
B- Bump the baseline
Highlight Ruler
E- Easy to read letters
S- Spacing
T- Tall letters tall… small letters small
!- Punctuation!
(Carroll, 2003)

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. 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. 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. Sensory Regulation: Common Tools
Lap Buddy
Theraband on Chair
Tennis Balls on Chair
Rocker
Body Sock Chair
Crash Pad
Move-n-Sit Cushion
Bean Bag Break Area

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. 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 (Lego's etc.)

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. 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. 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. QUESTIONS?

58. References (1 of 4)
 American Occupational Therapy Association. (2008). FAQ-Response-To-
Intervention. Retrieved 12 13, 2011, from AOTA:
http://www.aota.org/Practitioners/PracticeAreas/Pediatrics/Browse/S
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:
http://www.aota.org/Practitioners/PracticeAreas/Pediatrics/Highlight
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:
http://www.aota.org/Practitioners/PracticeAreas/Pediatrics/Fact-
Sheets-on-the-Role-of-OT/School.aspx?FT=.pdf

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 Children's 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:
User's 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. References: (3 of 4)
 Dunn, W. (1999). Sensory Profile. U.S.: The Psychological Corporation.
 Dunn, W. (2006). Sensory Profile School Companion: User's 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 teacher's guide. Cabin John, MD.: Handwriting
Without Tears, Jan Z. Olsen.

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 examiner's
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
leader's 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.