Other Therapies

Occupational Therapy

We usually hear about occupational therapy (OT) in a certain context: when adults are rehabilitated after a stroke, an accident or complicated surgery. Occupational therapy helps people to learn to do the activities of daily life – self-care and social skills, social interaction, education, work.

Why should children with LD/ADHD go through OT?

The main occupation of children is to play and learn. Children with LD/ADHD usually have issues with sensory integration, also known as Sensory Processing Disorder which hinders their ability to play and learn. Occupational therapy will help to integrate all the senses. Since we perceive, understand and behave according to what the senses tell us, a breakdown or disturbance in this neural pathway will cause changes in the way we behave. If a child’s auditory (hearing) sense is under stimulated (hypo) the child will not pick up all the sounds she hears. When she listens to a nursery rhyme (Ding, Dong, Bell) she may hear it as:

    • Ing, ong, ell,
    • Ssy’s in ell
    • Oo put in

    She’ll miss sounds and words.

    Sometimes LD/ADHD can occur along with one or more of the conditions listed below. OT together with Special Education are necessary for the child to be able to learn and to integrate into her environment

    Sensory Integration: Why It’s Important

    We experience the world through our senses. Our brain receives inputs from the environment through the sense organs. It processes the information and sends signals to our body. Our body reacts according to the signals it receives from the brain. How we receive sensory inputs affects our behaviour. Sounds simple! But, it’s a highly complex process. We have five main senses. They are:

          • Touch – Tactile
          • Sound – Auditory
          • Sight – Visual
          • Taste – Gustatory
          • Smell – Olfactory

    In addition to the five senses we also use two more senses:

    Vestibular or movement and balance sense

    This sense provides information about where the body is in space and in relation to the earth’s surface. When you wait at the traffic signal in your car which is stationary, and a bus next to your car moves, you get a feeling your car is also moving. Immediately your brain gets the right input and you realise the bus is moving. 

    Proprioception

    This sense provides information about all the parts of the body (joints and muscles), their position and what they are doing. If you are blindfolded and lift your hands in line with your shoulders, you know where your hands are. You don’t have to see them to know you have moved your hands away from your body. You are aware even if you don’t see with your eyes.

    When the five senses along with vestibular and proprioception work in tandem there is sensory integration.

    What happens when there’s sensory disintegration?

    Sensory disintegration can happen when the senses are over stimulated (hyper) or not stimulated enough (hypo). A child who may be hypersensitive to touch (tactile) will find brushing teeth extremely disturbing. For him, dental hygiene becomes a problem. Or a child may dislike certain fabrics and won’t want them rubbing against her body. So, she may refuse to wear certain kinds of clothes.

    Some children can’t tolerate loud voices, or music when their auditory sense is over stimulated. If their auditory sense is under-stimulated they won’t be able to pick-up certain sounds in speech. They mispronounce words and garble nursery rhymes.

    When there’s a problem with their vestibular sense and proprioception they’ll have trouble with directions, gauging distance – they can’t tell if they can jump 5 steps at a go, they just jump. They bump into things and people. They can’t maintain body space in relation to another person they are talking to. They either stand too close to you, or far away from you. They can’t sense the passage of time.

    If you were to walk along a street known for its street food, your brain automatically scans the stalls as you walk along the street, your body avoids brushing against another person in the crowd, your nose is able to discriminate the different aromas of food. Your brain gathers all this information, filters it and helps you make the decision to stop at the food stall of your choice.

    When there’s sensory disintegration – I will get all the above information at the same time without any filtering, and I won’t know what to do. My senses will be overwhelmed and my anxiety will increase. I may push and shove through the crowd, or stay rooted to the spot – either way, unable to decide what to do.

    Most of the time ADHD and SensoryProcessing Disorder occur together. (A term you’ll hear often is comorbid. Don’t panic. It means co-occuring or to occur along with.)

    How can I help my child?

    Your first port of call will be your paediatrician or Learning Centres which specialise in Learning Differences/Difficulties. Your child will be assessed to understand what kind of learning difference/disability they have. The specialist will refer you to an occupational therapist. The occupational therapist will draw up a plan according to the individual needs of the child. You, as a parent, have to work closely with the occupational therapist and the special educator/teacher. Be prepared for the long haul. 

    When you follow what the child requires, the results are obvious and significant. She will become confident in her abilities and this will reflect in academic success and positive behavioural changes in her interactions with peers and adults.

    Occupational therapy (OT) treatment focuses on helping people with a physical, sensory, or cognitive disability be as independent as possible in all areas of their lives. OT can help kids with various needs improve their cognitive, physical, sensory, and motor skills and enhance their self-esteem and sense of accomplishment.

    Some people may think that occupational therapy is only for adults; kids, after all, do not have occupations. But a child's main job is playing and learning, and occupational therapists can evaluate kids' skills for playing, school performance, and daily activities and compare them with what is developmentally appropriate for that age group.

    According to the American Occupational Therapy Association (AOTA), in addition to dealing with an someone's physical well-being, OT practitioners address psychological, social, and environmental factors that can affect functioning in different ways. This approach makes OT a vital part of health care for some kids.

    Occupational therapists might:

    • help kids work on fine motor skills so they can grasp and release toys and develop good handwriting skills
    • address hand–eye coordination to improve kids' play and school skills (hitting a target, batting a ball, copying from a blackboard, etc.)
    • help kids with severe developmental delays learn basic tasks (such as bathing, getting dressed, brushing their teeth, and feeding themselves)
    • help kids with behavioral disorders maintain positive behaviors in all environments (e.g., instead of hitting others or acting out, using positive ways to deal with anger, such as writing about feelings or participating in a physical activity)
    • teach kids with physical disabilities the coordination skills needed to feed themselves, use a computer, or increase the speed and legibility of their handwriting
    • evaluate a child's need for specialized equipment, such as wheelchairs, splints, bathing equipment, dressing devices, or communication aids
    • work with kids who have sensory and attentional issues to improve focus and social skills

    How Physical Therapy and OT Differ

    Although both physical and occupational therapy help improve kids' quality of life, there are differences. Physical therapy (PT) deals with pain, strength, joint range of motion, endurance, and gross motor functioning, whereas OT deals more with fine motor skills, visual-perceptual skills, cognitive skills, and sensory-processing deficits.

    Occupational Therapy Practitioners

    There are two professional levels of occupational practice — occupational therapist (OT) and occupational therapist assistant (OTA).

    Since 2007, an OT must complete a master's degree program (previously, only a bachelor's degree was required). An OTA is only required to complete an associate's degree program and can carry out treatment plans developed by the occupational therapist but can't complete evaluations.

    All occupational therapy practitioners must complete supervised fieldwork programs and pass a national certification examination. A license to practice is mandatory in most states, as are continuing education classes to maintain that licensure.

    Occupational therapists work in a variety of settings, including:

    • hospitals
    • schools
    • rehabilitation centers
    • private practices
    • children's clinics
    • nursing homes

    Finding Care for Your Child

    If you think your child might benefit from occupational therapy, ask your doctor to refer you to a specialist. The school nurse or guidance counselor also might be able to recommend someone based on your child's academic or social performance.

    You also can check your local yellow pages, search online, or contact your state's occupational therapy association or a nearby hospital or rehabilitation center for referrals.

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