mOTivated: the school-based OT

“School-based occupational therapy practitioners support academic achievement and social participation by promoting occupation within all school routines, including recess, classroom, and cafeteria time. They help children fulfill their role as students and prepare them for college, career, and community integration. They utilize prevention, promotion, and intervention strategies for mental and physical health and well-being. “

-AOTA

In my previous post OT: the art and science therapy,

we learned that   o c c u p a t i o n s   are used by occupational therapists as a therapeutic means to enhance quality of life, improve occupational participation, and promote physical and mental well-being. Well this same concept is utilized by school-based OTs with a primary focus on academics, social participation, leisure and play, as well as transitioning to work skills. In this setting, an occupational therapist may use her (or his) expertise to reduce barriers to participation within the classroom through environmental analysis and modifications among many other things.

  • Related service professionals—> occupational therapists are apart of a team of specialized instructional support personnel that are under Individuals with Disabilities Education Act (IDEA) as well as Section 504 of the Rehabilitation Act of 1973
  • It takes a village—> OT doesn’t work unless the parents, teachers, and other school staff are on board. It takes a team to promote occupational participation in these kiddo in order to support the child’s academic and behavioral needs as well as their functional performance

When it comes down to it, occupational therapy is anywhere and everywhere. Regardless of setting, OT helps

shanclients of all abilities and backgrounds to participate in their most meaningful occupations that are necessary or apart of their daily life routine.

 

Picture this.

In an ideal world, school-based OT would always occur inside the classroom with peer supports.

Imagine having two groups of six children at a table-a teacher at one table; the OT at the other table. Four of the children at the table with the OT have some type of developmental delay, high tone, and maybe just take a little more time to grasp academic concepts; these children qualify for OT services. Instead of removing the four children from the classroom, the eight other children participate in the intervention (with their four classmates) and become peer models. The OT may teach the teacher certain strategies to inhibit tone and increase the children’s attention span. To most people, the games or objectives of the intervention session may look like playtime… but in actuality the skilled occupational therapy practitioner  will use these “games” or activities to address a student’s physical, cognitive, social, emotional and sensory aspects of performance. 

***note: Don’t be a rude OT and pretend like you know the students better than the teacher who is with them all week. Teachers are invaluable to the success of the child; without them there would not be OT services provided in this setting. Thus, collaboration is key to benefit the student’s needs.***

However, sometimes it is necessary for the OT to pull the child out of the classroom environment to a smaller room. For instance, if the child has poor body awareness or is easily distracted by his classmates or by the classroom itself (yes, teachers are very creative and spend their money and time on classroom décor…. but for some kiddos, it is overstimulating!!) then the OT may arrange with the teacher a time for that student to receive therapy in a different environment…in addition to perhaps respectfully educating the teacher on why for some kids a crazy, beautiful, sparkly, multitextured room may spark some behavioral issues…

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Now before we dive deeper into school-based OT, I want to share a fine motor craft that another classmate and I created for our fieldwork Level 1 site (just think of this like a clinical rotation) at an all special needs school.

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The finished product

 

 

For this group session, six children of various cognitive and physical abilities and diagnoses sat at a rectangular table. As our warm up activity, we went around in a circle and introduced ourselves and said our favorite color. While this may seem very simple to you, for some of these children it is difficult due to oral motor impairments or recall limitations to recite their name and a color of their choice.

After the introductions, we showed an example of the final product. Each child received one paper rainbow and if cognitively capable chose the first color (red) out of the crayon box. For some children, it was necessary to limit the color choice down to two or three colors in order to help eliminate some of the wrong colors. This process was repeated until the rainbow was fully colored to the best of each individual student’s ability.

If strength and the ability to apply just enough force was not an issue than the kiddos were asked to break their fruit loops into halves. Each fruit loop half was matched to the colored rainbow stripe and glued piece by piece.

This activity was very challenging for some of the students due to their difficulty to attend to the task, low tone or high tone, grasp requirements, and more…

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Palmar Supinate Grasp-appropriate for 1-2 year olds

 

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Dynamic Tripod Pencil Grasp-mature prehension grasp pattern

 

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Pincer Grasp
  • Supplies needed for this craft include: rainbow stencils, crayons, fruit loops, and glue

  • Rationale: work on dynamic tripod grasp, pincer grip, color recognition, improve manual dexterity, in-hand manipulation, pressure modulation, visual perception, visual discrimination, and ability to follow directions

  • Grade down: to make this process easier set out only one item at a time until each step is completed, give verbal and tactile cues as needed

 

 

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Back to why OT in schools is fundamental and needed…

Occupational therapists in the school-based setting are pretty awesome and unique in the therapy world. According to the American Occupational Therapy Association (AOTA), some of the things an OT who works in schools may do in hopes to support participation includes the following:

  • Adapting activities and environments
    • Ex: modify playground equipment so that it is accessible for kiddos of all abilities; recommend that elementary students sit in weekly lunch groups to facilitate social interaction and communication
  • Collaborating with school staff
    • Ex: advocate for recess-kids need recess for their physical and mental health; teach Handwriting Without Tears
  • Increasing independence in daily living skills
    • Ex: promote organizational skills; address self care needs such as toileting or dressing-changing into gym attire
  • Supporting transition
    • Ex: kids aren’t kids forever-OTs help them transition to employment or assist them in community integration
  • Recommending assistive technology
    • Ex: recommending specific pencil grips to improve a child’s handwriting; recommending computer software specific to meet the child’s participation skills
  • Promoting positive behavior
    • Ex: this one is pretty simple-your child is more inclined to do well in school if he or she feels confident in his or her abilities; facilitate a positive learning environment to increase positive interactions
  • Supporting school mental health
    • Ex: initiate anti-bullying seminars; provide education to school staff on coping and calming strategies
  • Increasing attention
    • Ex: educate teacher on alerting activities for low tone children; recommend motor breaks
  • Addressing sensory, cognitive, motor needs
    • Ex: I don’t even know how to begin attempting to explain this one

 

Wait, I can’t afford occupational therapy services for my child.

Good news, occupational therapy is provided for freeeeeeeee in the school setting when determined educationally necessary. In public schools, federal, state, and local funding are used to cover the cost of skilled therapy intervention. There is this document called an individualized education program (IEP) for each student; the IEP team is the group that decides if a child qualifies for OT services.

As required by the Individuals with Disabilities Education Act (IDEA), parents can view their child’s performances and progress rate of their IEP goals which includes the occupational therapist’s goals for the child.

There is so much to learn about OT and I hope this post broadens your horizons on just one of the many settings you can find the art and science therapists!!

stay mOTivated,

SHANNEN M.

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OT: the art and science therapy

“The profession of occupational therapy will flourish because occupation, its core, is so basic to human health yet so flexible, depending on the needs of the individual human being.”

-DAVID NELSON

otco2016 (3)
USA Occupational Therapy Class of 2016

 

TO BE HUMAN IS TO BE OCCUPATIONAL.

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occupational balance

You may think you have never before been exposed to the wonderfuldynamic, and always present OT world, but in actuality you experience it everyday through the meaningful activities (occupations)that consume your time.

Everyone no matter their background, beliefs, culture, ethnicity, gender, age, disorder, disability, diagnoses, political opinion, it doesn’t matter–everyone-deserves to experience occupations.

Therefore, it is also important that the general public and even other healthcare professionals widen their horizon and come to terms with the benefits of occupational therapy. Be mOTivated to expand your knowledge on how this profession may impact you or your loved ones.

As a profession that has been around for 100 years (next year), it is my hope to advocate and educate others on the field I fell in love with and felt God’s hands pushing me toward many years ago-aka since 9th grade of high school (in addition to advocating for sunshine’s profession as a future doctor of osteopathic medicine, I hope to always be an advocate of occupational therapy!)

In this first OT Post I will share some of the questions some of my friends and family members have asked me about in regards to the profession that is both an art and a science!!

So is occupational therapy (OT) like physical therapy (PT)…

No, not quite. Yes, physical therapists and occupational therapists often co-treat and attend to the same clients. Yes, they often will collaborate to design and implement the most appropriate client-centered intervention plan and goals. And yes, they both integrate their therapeutic use of self during the treatment session to build rapport and develop trust with each individual client. To be honest, there is a lot of overlap; however, there are definite and notable differences that I will expand on later. Nevertheless, both professions are blessed to inspire and improve the functional outcomes of an individual at oftentimes a very personal level.

“occupation”- activity in which an individual client is engaged// “physical”- of or pertaining to the body

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PT perspective: great knee extension a few days post my second ACL reconstruction surgery

 

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OT perspective: look at that community mobility and resilience

Physical therapists are here to help restore your mobility. They are well-versed in the anatomy and physiology of the body and are predominantly utilized in the physical rehabilitation of individuals recovering from injuries or diseases. These professional healthcare workers also work in a variety of settings. PTs help you manage your pain and also may teach preventative methods as well. PTs are well-equipped to prepare and implement individualized patient plans. They are concerned with muscle strength and overall motor development. They are very important and after four clinical rotations (level 1 fieldwork) where I collaborated with them in addition to -from my own personal experience as a stubborn but very diligent patient- three knee surgeries later, I love my PT friends.

Occupational therapists also take into consideration the physical rehabilitation standpoint, but with a twist. We like to see y’all get back to performing those activities of daily living–the meaningful occupations of your day-to-day life–in the way that is most functional and easiest for you! Through the therapeutic use of occupations, we are healthcare professionals that are dedicated to helping our clients meet their occupational needs. In addition to using occupations as one of our modes of therapy intervention, we take into consideration the client’s context and think of nifty environmental modifications. We are very crafty with our modifications and utilize assistive technology as needed. An understanding of mental health is very important to OTs, because we design intervention plans that can be graded down or up depending on the client’s abilities and skill sets.                 OT is awesome, just saying.

My PT friends will help you walk, but OTs will TEACH YOU TO DANCE 🙂 and dance with you!

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occupational therapy & osteopathic medicine = dynamic dancing duo

 

But occupational therapists help you find jobs right?

Well yes, but no because that is literally like a teeny tiny fraction of what an occupational therapy practitioner can do for you. For instance, perhaps you have worked as an auto-mechanic for the past 20 years but now you are having difficulty performing your work tasks due to decreased function of your hands and shortness of breath. Well an OT working as an ergonomic consultant (which is probably the last setting/area of practice I see myself working in) can do a plethora of things for you such as…..   

  1. advocate for your supervisor to give you increased time to complete your duties
  2. perform a Work Capacity Evaluation-a universal full body test that addresses how one performs the tasks necessary to succeed in a specific job and also entails a detailed interview that determines the consistencies of work performance and more
  3. recommend you have a schedule that includes increased rest breaks and/or determine if any of the work duties can be executed in a seated position rather than standing
  4. create a home exercise program that is tailored to fit and improve your strengthening and endurance abilities.. the list goes on —-and that is only one of many settings where an OT can work
    1. ***in the future will expand on each of the environments an OT can work through individual posts about the different settings such as in a hospital setting, inpatient rehabilitation, outpatient rehab, hand clinics, schools, skilled nursing facilities, and many more***

 

Well then what does the term “occupation” mean if OT is not really about finding people jobs?

The term “occupation” refers to meaningful activities. From an OT lens, it is through the therapeutic use of these everyday life occupations (not to mention evidence-based of course) that a client’s functional well-being can be restored to enable participation in multiple settings. Occupations may be simple, ordinary things such as reading your favorite magazine, babysitting your neighbor’s children, driving to the local grocery store… but also they may be special such as when you master cooking the family Christmas dinner or when you mindfully choose to volunteer your time at like a youth church group.  Perhaps the best way to describe/define occupations is to reference the Occupational Therapy Practice Framework-3rd Edition.

“Occupations are various kinds of life activities in which individuals, groups, or populations engage, including activities of daily living, instrumental activities of daily living, rest and sleep, education, work, play, leisure, and social participation.”

 

The following occupations exemplify occupation-based interventions in skilled therapy sessions used to facilitate growth or change in client factors (body functions, body structures, values, beliefs, and spirituality)…

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IADL/education-community outreach

 

  • ACTIVITIES OF DAILY LIVING (ADLs)–these are the basic activities you do everyday to take care of yourself and are the fundamentals people!!
    • Bathing, toileting, dressing, eating, feeding, functional mobility, personal device care, personal hygiene, sexual activity
  • INSTRUMENTAL ACTIVITIES OF LIVING (IADLs)–these are those activities you do to support your home and community; more difficult typically than ADLs
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    ADL-eating; IADL-thanks for the weekly meal after mass, South Alabama Catholic Student Association
    • Care of others, care of pets, child rearing, communication management, driving and community mobility, financial management, health management and maintenance, home establishment and management, meal preparation and cleanup, religious and spiritual activities, safety and emergency maintenance, shopping
  • REST AND SLEEP–restorative rest and sleep are vital to optimal functioning in your favorite activities
    • Rest, sleep preparation, sleep participation

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      work/education/leisure-studying poolside in the “winter”
  • EDUCATION–these refer to what you need to do learn and participate in educational environments
    • Formal educational participation, informal personal educational needs, interests exploration
  • WORK–because you can’t play all the time; this occupation includes the actual labor it takes to perform a task; how you organize, plan, or execute the task; constructing, manufacturing, or creating something with or without monetary reward
    • Employment interests and pursuits, employment seeking and acquisition, job performance, retirement preparation and adjustment, volunteer exploration, volunteer participation
  • PLAY–adults play too!! This refers to spontaneous
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    education/social participation-3 semesters worth of research with my mindfulness fam

    or organized activity that provides you with entertainment, diversion, or enjoyment

    • Play exploration, play participation
  • LEISURE–include leisure in your everyday life or you my friend will have a terrible case of occupational imbalance… This occupation refers to participating in nonobligatory activities in your discretionary time. These are the intrinsically motivated activities you do when you aren’t boggled down with life demands such as work, self-care, or sleep
    • Leisure exploration, leisure participation
  • SOCIAL PARTICIPATION–All beings are occupational. All beings need to interact with each other!! This occupation refers to an interweaving of occupations to support community engagement. All about being social and creating interdependence
    • Community, family, peer, friend

 

While many occupations seem “ordinary”, it is only through the individual client’s perception that these activities transform into meaningful occupations.

Stay mOTivated,

SHANNEN M.

For more information on physical therapy check out APTA.org

For more information on occupational therapy check out AOTA.org

American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1-S48.