By: Laura Van Zandt, OTR/L
I’ve been an occupational therapist for seven years and it’s taken a long time to perfect the answer to the question “What is OT?” from people I just met. Today, I think I finally have a good answer.
To begin, occupational therapists see individuals across their lifespan and in a variety of different settings. We work closely with medical staff, parents, and educators. Typically there is some underlying problem that has initiated a meeting with an occupational therapist.
Depending on their training, there are a number of different approaches an OT may take to solve the problem. One approach is the “Person, Environment, Occupation” (PEO) model. The PEO model (Law et al., 1996) is a well-known and established conceptual model of practice within occupational therapy. It offers a foundation for guiding assessment and intervention across all practice settings and client populations.
This model of practice helps an OT consider the whole child…their roles, activities, where their performance may need help, areas of strength, and more. Since I work with children, I am going to define the person as a child. The environments are the places a child interacts (e.g. home, school, community) and the occupations are the things he/she does in those places (e.g. get dressed, feed themselves, learn to write/color/draw, play). It is an occupational therapist’s job to evaluate a child and determine what makes it hard for those occupations in all his/her environments. It could be strength, sensory, visual, etc. or a combination of all those areas. It could also require a team approach, short term services, or long term services.
Let’s look at an overview of the assessment process with a simple case study to make it easier to understand:
ASSESSMENT PROCESS (Person, Environment, Occupation)
Referral: A 7-year-old is referred by a doctor for occupational therapy services based on her parents’ concerns with difficulty sitting still at home and completing homework tasks. She also has difficulty focusing and getting ready for the morning.
An OT would consider the child’s role as both a developing child, sibling, daughter, student, and friend. What is preventing her from participating fully in those roles? We would also consider the family’s values, interests and daily roles. We try to look at the client’s pattern of engagement in occupations (i.e. getting ready) and how they changed over time.
In the example above, we would consider the entire family. This child has many roles. She is not only a child of a two parent working family, but she is also a sibling with a younger brother. She is also a first-grade student. In further conversations, we discover she also participates in gymnastics after school. In order to best support this child and her family, we would need to consider each of those roles and how they contribute to the overall profile of this child.
Occupational Performance Areas:
Then we consider the areas of occupational performance (e.g. activities of daily living, instrumental activities of daily living, rest and sleep, education, play and leisure, and social participation).
In the example above, this child is possibly presenting concerns with activities of daily living. Specifically, we might look at her ability to dress herself and completing grooming/hygiene tasks. Her mother, also mentions the child is having difficulties with staying focused and managing her assignments in school. Is this also impacting her social participation both at home, school and community where she does gymnastics?
Occupational Performance Components:
What components need to be addressed that may explain underlying difficulties?
Body Structure and Function – This may include muscle tone, range of motion, posture and alignment, postural control, strength, joint stability, endurance, fine motor skills, manipulation and dexterity, gross motor skills, coordination, bilateral coordination, etc. We may also evaluate her nutrition, respiration and gastrointestinal background to make referrals.
Sensory motor – This may include a child’s under or over responsiveness to touch, movement, sight, sound, taste and smell as well as their visual perceptual skills and body awareness. This may also include a child’s behavioral responses to activities.
Cognitive – This may include perceiving, understanding concepts, learning, and executive function skills (initiating, planning, organizing, sustaining, sequencing, flexibility, problem solving, managing emotions, etc.). We may make referrals to further understand the role cognition plays in your child’s abilities.
Social-Emotional – This may include self-regulation, self-esteem, as well as inner drive and motivation to participate in activities. It could also include the ability to relate to other children and adults.
In the example referral above, we would need to determine what areas of occupational performance are making it difficult for her to participate to the best of her abilities. We could evaluate her strength by having her climb to see how she manages her body in space and uses her arms to support her body weight. We might also look at her core strength to see if she is weak and if that is causing her to feel unstable while sitting which impacts focus (e.g. if she is having to concentrate hard on keeping her body upright to be able to use her eyes and hands, then it will be hard for her to also concentrate on math facts).
We will also look at her hand skills. There might be concerns with weakness, grasp, manipulation, etc. that make it hard for her to use writing tools to complete tasks.
We can create a sensory profile, by asking questions, having a parent fill out questionnaires, and observing a child during activities. We would use our background in sensory integration too during our observations. For example, perhaps the feeling of clothing is too irritable to this child and she is having trouble focusing because she is needs to move to readjust how her clothing feels on her skin. We can evaluate vision to determine if we need to make a referral to another doctor. By planning some activities to do together, we can look at how her sequencing and planning behavior.
Finally, occupational therapists are mindful of the social-emotional development of children and how difficult things impact his/her daily function. We might ask the parent further questions if we notice that she is getting frustrated easily during a task and has trouble managing her frustration.
There are many hats that an OT wears in this therapeutic relationship….another adult, parent, teacher, friend, etc. When we begin, we often know very little about each other. However, we work together and figure out plans that best help a family address their wants for their child. In the process, we may not know all the answers yet and it may take time to figure them out. That is one of the hard parts of an OT’s job but also a fun aspect too. Wearing these different hats while at the core serving as an occupational therapist, is what I love about my job. To learn more about Easter Seals DuPage & Fox Valley’s occupational therapy services visit: http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/occupational-therapy.html.