Pediatric Occupational Therapy
Coordinator: T.O. Natalia Leoni
What is Occupational Therapy?
Occupational Therapy is a healthcare profession based on the principle that every individual seeks effective interaction in his/her environment and that health is the outcome of the capacity to perform with satisfaction those tasks (occupations) which are significant and relevant to the individual according to his/her age, interests and life roles. Play, learn and self-care, for example, are some of the activities which “occupy” a child.
The Occupational Therapy service at FLENI involves prevention, functional evaluation, treatment and identification of daily living skills such as self-care (eating, toileting and dressing), productivity (pre-school and school tasks), play and recreation (leisure) to increase independent functioning and enhance the development of children experiencing difficulties to perform activities of daily living. This service also includes adapting tasks or environments to achieve maximum independence and enhance quality of life.
Underlying skills are needed for a child to perform functional tasks such as putting shoes on, tying shoelaces and keeping pace with classmates’ handwriting. These skills are called occupational performance components. These components, such as dexterity, fine motor coordination, visual processing and visual perception, sensory processing and modulation, motor planning and motor organization, among others, lead to effective performance and participate in each performance area. If any of them is damaged, it may interfere with one or more tasks.
The Pediatric Occupational Therapy delivers care for children and adolescents with:
Deficits or delays in occupational performance in one or more of the following areas:
· Self-care activities include activities such as dressing and undressing, organizing and planning the different steps to put on a garment correctly; the garment and body spatial awareness; buttoning and unbuttoning; feeding; the correct use of the spoon, fork, knife and glass; grooming; fixing toileting elements; brushing your teeth; washing your face and hands and redressing after going to the bathroom, among other self-care activities.
· Educational / productivity activities: include activities that are necessary for the educational and academic development of the child. These are pre-academic, academic and pre-vocational activities, and comprise using school tools, scissors, handwriting and personal computers. They also include responsibilities at home such as the organization of routine activities, school work and extra school work.
· Play and recreation activities: include exploration and involvement skills identifying interests, abilities and challenges according to the age of each child. The active involvement in play activities promotes a more efficient processing of sensorimotor, cognitive and psychosocial skills and the integration of sensory systems. On the other hand, the ability of a child to participate in a highly motivating, funny and satisfactory activity depends on his/her play and recreation skills.
Evaluation
Briefly, occupational therapy evaluates:
1. Child/adolescent performance in everyday life activities in three areas: self-care, productivity (pre-school, school and pre-employment activities) and play.
2. Performance components.
3. Performance context (child/environment relationship).
The evaluation is conducted by means of clinical observation or assessment through the administration and interpretation of standardized or non-standardized tests and measurement of the ability to perform. The Wee-FIM or the COPM tests identify the effectiveness of daily life performance and the degree and type of assistance needed in each case.
Other examples: children with sensory processing and modulation disorders who must improve their daily occupational performance are evaluated with Gangi’s Test of Sensory Functions in Infants (TSF), Winnie Dunn’s Sensory Profile, -Sensory History, -Clinical Observation based on Sensory Integration, among other observation guidelines in terms of rules and qualities according to the age of the patient.
Motor skills are evaluated with Bruininks Oseretsky’s Test of Motor Proficiency (BOTMP), Peabody’s Development Motor Scale, (PDMS II).
Additionally, visual-motor, visual-reception and visual-cognition skills are evaluated using other specific tools.
What treatment do we provide?
The treatment programs delivered at FLENI enhance the occupational performance and quality of child and family and are customized to address the individual needs and expectations of each patient and his/her support system (family, school and social environment).
The most common treatments provided at FLENI are: Neuro Developmental (NDT), Sensory Integration, Biomechanical, Rehabilitation, Human Occupational Model and Client-Focused Canadian Model which can be delivered in conjunction.
At FLENI we also implement specific teaching and training handwriting techniques (“Escritura sin Lágrimas” by J. Olzen and “Grupos y otros vinculos” by M. Benbow.
CETNA includes
-Consultation Offices
-Admission Modules (interdisciplinary evaluation and diagnosis)
-Intensive Comprehensive Rehabilitation Modules
-Therapeutic School
-Inpatient Services
The Occupational Therapy service participates in the five services mentioned above.
Consultation Offices
Occupational Therapists specialize in the evaluation and treatment of children/adolescents with a delay or deficit in their daily living performance, grooming, play and schoolwork. Referrals to our Occupational Therapy Service come from different sources such as attending physicians (pediatricians, neuropediatricians, infant psychiatrists, neuroorthopedists, etc.); school recommendation; or, their parents or relatives. Our Occupational Therapists provide treatment to children with performance disabilities, such as, a child with Down’s syndrome who has difficulties to learn how to use the spoon at lunch (self-care limitation), a child with Cerebral Palsy who shows a deficit in the exploration of the physical environment in the kindergarten during play (play limitation) and in writing and motor abilities, children with Attention Deficit and Hyperactive Disorder (ADHD) who, in first grade, find it difficult to adapt themselves to the routine of the class, sustain attention, and feel committed to the assignments due to his/her problems to bear the sensory stimuli of the environment (academic limitation).
Admission Modules
Our Pediatric Occupational Therapy Service participates in the admission modules together with an interdisciplinary team to provide an accurate diagnosis after evaluation. The therapies prescribed in these modules establish the rehabilitation plan that is most effective for each patient.
Intensive Comprehensive Rehabilitation Modules
The primary goal of the Module is to reach the optimal functional performance of the child/adolescent so he/she can achieve independence in the community.
Evaluation of daily life abilities and upper extremity functioning of the child and/or adolescent helps to identify difficulties and develop a customized treatment plan with the family.
In a single setting to facilitate communication, our pediatric occupational therapists work with an interdisciplinary team using state of the art techniques to design integrated plans comprising the physical, cognitive and emotional aspects.
They also evaluate the equipment for the patient as well as the necessary adaptations to the surroundings of the child and the corresponding training for family and child.
Inpatient Services
The service is delivered at our PROTECTED GYMNASIUM:
This room was specially created for children in coma, minimal conscious state and/or sustained vegetative state and provides an adapted environment with the necessary stimuli in terms of intensity, frequency and rhythm for emergence from these conditions.
Basically, we work on an interdisciplinary basis.
The goal of Occupational Therapy in pediatric cases of minimal conscious state is to provide a high quality environment with a planned and gradual stimulus for children to achieve a finely tuned and oriented response to stimulus, an increase in the state of consciousness focusing on a gradually higher level of adaptative motor response, using in an integral manner auditory, visual, sensory, olfactory- vestibular and propioperceptive stimuli, graduating their intensity, frequency and rhythm.
Educational & Therapeutic School
The role of the Occupational Therapist at school focuses on three major goals
1. Increase self-care skills
2. Increase handwriting and motor skills and improve school tools manipulation (the daily life tasks of a child are based on fine motor and visual skills)
3. Increase skills to use sensory input to understand and interact effectively with people and objects both at home and at school
Most CETNA’s Educational & Therapeutic School students have difficulties in their daily occupational performance secondary to the disorders in the sensorimotor, cognitive and psychosocial components. Frequently, these children have sensory difficulties to process and modulate that call for a theoretical and practical Sensory Integration therapy.
The pediatric occupational therapist evaluates the child’s performance in relation to his/her school needs and provides assistance to teachers and parents.
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