Occupational Therapy LECTURE 07

program of treatment
 Setting the goals of treatment
Occupational Therapist sets two types of Goals

Short term goals: are based on the present functional level

of the child according to his age

Long term goals: are based on the predicted functional level

of the child and expectation of the parents.
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 Things to take care about
Development occurs in a sequential fashion.

This means that a child will need to develop some skills before he or she can
develop new skills.

For example, children must first learn to reach before they are able to grasp
a pen.

Each milestone that a child acquires builds on the last milestone developed.

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Treatment approaches in
occupational therapy
 Occupational Therapy theories
Combination of these therapies can:
1. Promotes independence
2. Increases participation
3. Facilitates motor development & function
4. Improves strength
5. Enhances learning opportunities
6. Eases caregiving
7. Promotes health & wellness
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 1. Sensory Integration Therapy
It is the process of organizing information from the body and
the world around for use in the daily life

It is based on the hypothesis that in order to develop a

normal adaptive response, the child must be able to optimally
receive, integrate and process the sensory information.

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Many children with cerebral palsy and other neurological
conditions have associated sensory difficulties.

A therapeutic environment is created in which the child

gains rich sensory motor experiences and engages the child
in challenging play activities

the child is able to overcome the challenge and adapts to

subsequently face more challenging stimulus.
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 Most Commonly Known Senses
1. Vision 5. Touch
2. Hearing 6. Vestibular
3. Smell
7. Proprioception
4. Taste
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 Proprioception
• Gives awareness about Body positions.

• Unconscious awareness of sensations received through proprioceptors of joints,

muscles, ligaments, and tendons.

• Tells the brain when and how the muscles are contracting and stretching and
how joints are bending, extending, being pulled, or compressed.

• How to develop sense of body position?

– Deep pressure and gentle “pull” to the joints

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 Vestibular Sense
Inner ear detect movement and changes in the position of head

• Supports “extensor” tone-holding body up against gravity

• Helps us know up/down; right/left

• How to develop sense of movement and balance?

– Do rhythmic movements to the child to calm the vestibular system or irrhythmic

movements to stimulate it.

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 Sensory Integration Dysfunction
Inability to process the information received through senses:

• Affects learning, development, and behavior

• The muscles and nerves may work well, but the brain has a difficult time
organizing or integrating the information.

• Shows difficulty in organizing themselves, in school/play activities

• Less involvement in positive social experiences.

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 Tactile Dysfunctions
1. Hypersensitivity or Tactile Defensiveness:

– React negatively and emotionally to light touch, exhibiting anxiety,

hostility, or aggression

– Avoidance of new or certain textures of clothing/food.

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2. Hyposensitivity or Under-Responsiveness:

-Tend to repeatedly touch surfaces that provide comforting tactile

experiences

-Rub or bite own skin

-Prefer certain foods such as extra spicy or extra sweet foods

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 Vestibular Dysfunctions
1. Hypersensitivity or movement intolerance:

– Dislike activities such as swinging, spinning, or sliding

– Show discomfort being held in some positions, especially with head

tilted back

– slow moving and sedentary

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2. Inefficient vestibular processing:

– Need to keep moving or have trouble sitting still

– Repeatedly shake head back and forth, rock back and forth, and jump
up and down

– Crave intense movement experiences such as bouncing on furniture or

seeking fast and scary rides at amusement parks
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 Proprioceptive Deficits
• Show poor body awareness, such as poor position in sitting or

using toys

• Seek sensation to the joints as in pushing head into corner of

crib or leaning into others

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 Other signs and symptoms
• Problems in motor planning(Inability to conceive, organize, sequence and carry
out complex movements in meaningful way-climbing stairs, clapping out rhythms)

• Poor eye-hand coordination(illegible handwriting ,untidy eating)

• Delays in speech, language ,motor skills, or academic achievement.

• Poor self concept

• Social and emotional problems

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 2. Constraint Induced Movement Therapy
(CIMT)
Involves intensive targeted practice with the affected limb while restraining the
non-affected limb

Children with hemiplegic cerebral palsy are forced to use their affected limb

Duration of constraint: there is no consensus but 2 hours per day

Intervention duration: in general CIMT is applied for 6 consequent weeks and

longer

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 3. Bimanual Training (Bilateral coordination)
Bimanual training or Hand Arm Bimanual Intensive Therapy (HABIT) provides
intensive training of bimanual coordination to enable practice of bimanual
skills.

developed in response to identified limitations of Constraint Induced

Movement Therapy

Bimanual training does not use any physical restraint allowing practicing
bimanual activities typically by providing explicit instructions

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This approach might be difficult in younger pre-school
children but it is better for school aged children

Age-appropriate fine motor bimanual activities using motor

learning approaches can be used whereby the children should
be actively engaged in problem solving.

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 4. Context-focused Therapy
Different environments may result in different solutions

In the same environment; different children may demonstrate different

solutions

Recent treatment models consider task completion and improvement of

function as the main outcome measures for rehabilitation interventions
rather than remediation or normalization of movement components.

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It is the interaction between the child, the task and the environment
which results in producing efficient solutions for functional tasks and
motor goals

Context-focused therapy targets changing identified constraints in the

environment contrasting to facilitating changes in the child’s
movement. The goal is to change the task or the environment to
promote functional performance. A possible approach could look as
follows:
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1. Identification of motor-based tasks a child was initiating, trying to modify
or showing an interest into.

2. Identification and analysis of constraints in the task through analysis of

task performance together with parents, child and therapist.

3. Treatment is focused on changing the environment or the task, ideally in a

natural environment (school, at home, etc.)

The context-focused approach described above is ideally combined with

goal-directed training as the combination is more effective than each
component separately

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 5. Goal-Directed Training / Functional Training

setting meaningful goals are crucial for

progressing
Introduce the tasks as a goal directed
exercise
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 6. Fine Motor Control
Improvement of hand dexterity by working on:
1. Hand muscle strength
2. Finger isolations
3. In-hand manipulations
4. Arching the palm of the hand
5. Thumb opposition
6. Pincer grasp

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 7. Upper Body Strength and Stability
Strengthening and stabilizing the trunk
(core), shoulder and wrist muscles
through exercises, such as crawling, lying
on the tummy while reading
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 8. Crossing the Midline

For example making figure eights

with streamers and throwing balls at
a target to the right or left of center.
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 9. Visual Motor Skills
Improving hand-eye coordination
through activities like drawing, stringing
beads or macaroni and catching and
throwing a ball.
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 The Critical Role of the Family
Parents and families have the primary role in children’s development.

Pediatric Occupational Therapists can assist the family with enhancing the child’s
development through:

1. Positioning during daily routines and activities

2. Adapting toys for play

3. Expanding mobility options

4. Using equipment effectively

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Thank You!