Areas Addressed in Occupational Therapy

  • Gross Motor Development

    Control over actions that help infants get around in the
    environment

    • Muscle tone

    • Gravitational Insecurity

    • Joint integrity

    • Large muscle movements

    • Balance reactions/reflexes

    • Postural/positioning

    • Range of Motion/stretching

    • Dyspraxia

  • Fine Motor Development

    Small, more redefined movements

    • Prerequisite skills

      • Children develop motor skills in a cephalo-caudal,
        head-to-toe direction. Head and shoulder control are
        necessary for fine motor skills.

      • Children develop movements in a proximal-distal, close
        to body (proximal) to an away from the body (distal)
        direction.

      • Stability of the joints is required before mobility.
        Children must learn to dissociate small and large
        movements

    • Prehension or Hand Skills

      • Requires

        • palmer arch development

        • digital (finger) manipulation

        • upright, comfortable posture

        • stabilization of shoulder, elbow, and wrist joints

        • open web space in thumb area

        • ulnar side of hand (pinky side) primarily used for power radial side of hand (thumb side) primarily used for skill.

      • Scribbling/coloring (sequence)

      • Bringing writing tools to paper

      • Random scribbles

      • Scribbles in horizontal direction spontaneously

      • Scribbles in a vertical direction spontaneously

      • Scribbles in a circular direction spontaneously

      • Imitates horizontal direction scribble

      • Imitates vertical direction scribble

      • Imitates circular direction scribble

      • Writing

        • Write on a vertical surface to promote wrist extension
          and thumb opposition

        • Work surface should be tilted 20°

        • Paper should be slanted 30°  to the left for right handed
          children

        • Paper should be slanted 30o to the right for left handed
          children

        • Sequence of stroke creation

          • Imitates/copies horizontal stroke

          • Imitates/copies vertical stroke

          • Imitates/copies circular stroke

          • Imitates/copies a plus

          • Imitates/copies a right/left diagonal

          • Imitates/copies a square

          • Imitates/copies a left/right diagonal

          • Imitates/copies an “x”

          • Imitates/copies a triangle

          • Imitates/copies a diamond

      • Scissor skills

        • Prerequisites

          • Balance

          • Shoulder stability

          • Forearm control

          • Wrist stability

          • Grasp

          • Finger isolation

          • Release

          • Lead-Assist Two-Hand Usage

          • Arm, hand, and eye movement coordination

          • Developmental readiness

      • Refined grasps

        • Buttons

        • Snaps

        • Pincer grasps

        • Isolating finger movements

      • Visual/perceptual skills

        • Hand/eye coordination

        • Reading comprehension

        • Written expressions

        • Visual attention

          • Alertness

          • Selective attention

          • Visual vigilance

          • Divided attention

        • Visual discrimination

        • Visual closure

        • Figure ground

        • Form constancy

        • Visual closure

        • Depth perception

        • Position in space

        • Visual-motor integration

  • Adaptive/Self-Help Skill Development a.k.a. Activities of Daily Living (ADLs)

    • Feeding/Oral Motor Skill Development

      • Rooting reflex

        • Integrates at 3 months of age

        • Aids child in finding nipple for a source of nourishment

        • Delay here may lead to decreased ability to feed independently

      • Suck/swallow/breathe (SSB)

      • Decreased coordination may lead to :

      • aspiration

      • Increased likelihood of pneumonia

      • Increased likelihood of chronic lung problems

    • Bite reflexes

    • Chewing

    • Texture manipulation in oral cavity

    • Liquid control in mouth

    • Hyper responsive gag reflex

    • Decreased lip closure/lip control

    • Tongue thrust/tongue rotation

    • Poor endurance

    • Head control

    • Body positioning

    • Facts/Information regarding feeding skill development

    • Gain control from back of mouth forward

    • As an infant, 4/5 of the child’s mouth is filled with the tongue and as oral cavity grows the soft palate forms and the tongue begins to take up less space in the mouth

    • Fat pads (cheeks) need to decrease for skill to develop

    • 90% of feeding preparation of the child to take in the sensory input that accompanies feeding, SUCCESS = STATE

    • decrease external stimulus

    • decrease excess noise/lights

    • remove inappropriate or unnecessary sensory input

    • be aware of child’s posture/position:

    • ENSURE CHILD FEELS SUPPORTED AND POSTURALLY STABLE

    • be aware of head control

    • Grooming

    • Hygiene

    • Toileting

    • Dressing Skills

    • Sleep and sleep related difficulties

    • Safety

  • Cognitive/Academic Skill Development

    Learning is based on our ability to manipulate the environment

    Delays occur because of difficulty in ability to access things in the environment

    The ability to acquire, store, and use information from the environment

    • Problem solving

    • Object permanence

    • Cause and effect

    • Imitation

    Social and Social Emotional Skill Development

    • The ability to regulate responses to others and the environment

    • Temperament

    • Ability to interact

    • Attention

    • Coping

    • Activity level

    Sensory Processing skills

    • Splinting

    • Indications for use

    • Deformities or for children at risk for deformities

    • Increased tone

    • Limited range of motion

    • Limited functional hand use

    • Goals for splinting

      • Prevent and/or correct deformity

      • Protect weak muscles and lax joints from inappropriate movements or overstretching

      • Prevent muscle imbalance

      • Strengthening weak muscles

      • Provide support

      • Encourage use of normal developmental movement patterns

      • Increase functional use of extremity

    • Adaptive Equipment

    • What is the purpose of the equipment piece?

    • Is it parent and/or child friendly?

    • Is it functional and mobile for the family to adapt to various situations?

    • How will the equipment increase the child’s function?

    • Is it developmentally appropriate?

    • Can the child be instructed to manipulate the device?

    • Can it be considered unobtrusive?

    • Is it economically possible for the family?

    • Will it grow with the child?