Occupational Therapy (OT) Blog and Resource website
Hello, We are Payal and Deepam. We both are Occupational Therapist. We deal with special kids and adults with neuro impairment.. This site can be referred as OT resources for therapists, educators, special needs teachers, and parents/caregivers and other health care professionals.
Down syndrome is a genetic disorder caused when abnormal cell division results in extra genetic material from chromosome 21. Down syndrome is a naturally occurring chromosomal arrangement that has always been a part of the human condition, being universally present across racial, gender or socio-economic lines, and affects approximately one in 800 births worldwide. Down syndrome is a condition that is present at birth, which affects the body’s physical and mental development.
Normally, a child inherits two copies of chromosome 21 – one from each parent. If a child inherits an extra chromosome 21, the child will have Down syndrome. Because Down syndrome usually affects every cell in the body, people can have a variety of medical problems.
While no two children with Down syndrome are exactly alike, they do share some common physical features. Babies with Down syndrome have similar facial features, tend to have lower muscle tone, and typically learn to walk and talk slightly later than other children.
Children with Down syndrome have a distinct facial appearance. Though not all children with Down syndrome have the same features, some of the more common features are:-
● A slightly small head that is flattened in the back;
● Up-slanted eyes;
● Extra skin folds at the inner corners of the eyes;
● Small ears, nose and mouth;
● Short stature;
● Small hands and feet…and
● Some degree of intellectual disability.
Treatment of down syndrome-
Down’s Syndrome cannot be cured. There is no medicine or treatment that can eliminate the existence of the extra chromosome. However, it has now been found that early intervention and training in fields of speech and play can help these children to become independent in daily life skills.
Early intervention is a systematic program of therapy, exercises, and activities designed to address developmental delays that may be experienced by children with Down syndrome – with the goal of enhancing the development of infants and toddlers and helping families understand and meet the needs of their children. The most common early intervention services for babies with Down syndrome are physical therapy, speech therapy, and occupational therapy.
Down syndrome and Occupational therapy
Children with Down syndrome want to do what all children want to do, they want to sit, crawl, walk, explore their environment, and interact with the people around them. To do that, they need to develop their gross motor skills. Because of certain physical characteristics, which include hypotonia (low muscle tone), ligamentous laxity (looseness of the ligaments that causes increased flexibility in the joints) and decreased strength, children with Down syndrome don’t develop motor skills in the same way that the typically-developing child does.
Motor development is a core issue in the development of every child. And children with down syndrome generally lack in the motor development.
Infants with down syndrome typically have central hypotonia (floppiness without weakness) and, as a consequence, gross motor skills are delayed. Most children with down syndrome do not sit up until 1 year of age or walk until 2 years (Melyn & White, 1973).
The Goal of occupational therapy for these children is not to accelerate the rate of their development, as is often presumed, but to facilitate the development of optimal movement patterns. This means that over the long term, therapist want to help the child develop good posture, proper foot alignment, an efficient walking pattern, and a good physical foundation for fine motor skills, and activities of daily living.
When the down syndrome child is an infant, parents immediate concerns relate to his/her health and growth, development of the basic motor milestones, social interaction with parents and others, interest in things going on around him/her, and early speech sounds and responses.
Early Intervention for down syndrome child –
Assist with oral-motor feeding problems (this can also be addressed by Speech therapist). Due to hypotonia and weakness of the muscles of the cheeks, tongue, and lips, feeding is difficult for some infants with Down syndrome. OT suggests positioning and feeding techniques.
Help facilitate motor milestones, particularly for fine motor skills. Occupational therapists and Physical therapists work closely together to help the young child develop gross motor milestones (eg: sitting, crawling, standing, and walking). Occupational therapist works with the child at this stage to promote arm and hand movements that lay the foundation for later developing fine motor skills. The low muscle tone and loose ligaments at the joints associated with Down syndrome are real challenges to early motor development and occupational therapy can help the child meet those challenges.
Most children with Down syndrome learn to speak and will use speech as their primary means of communication, they will understand language and have the desire to communicate well before they are able to speak. Total communication, using sign language, pictures can serve as a transitional communication system. Parents are the primary communicators interacting with their babies and young children; thus, parents can do a great deal to help their children learn to communicate. Many of pre-speech and pre-language skills are best learned in the home environment.
Occupational therapy Assessment in down syndrome child-
The child with down syndrome delays in gross motor skills, fine motor skills, cognitive skills, and communication.
OT may use different formal or informal tests to assess down syndrome child.
OT checks following sensorimotor components-
Range of motion
Coordination and balance
Cognitive and perceptual component it includes-
Behavior Tantrums and Communication (verbal & non verbal).
Occupational therapy intervention for down syndrome-
Occupational therapist plan out the intervention strategies depending on the issues with the specific down syndrome kid. Occupational therapist takes different functional activities to promote function in the down syndrome child.
Activities use by the OT is more of a play kind and functional. OT provides early intervention services to the infant and toddlers having down syndrome.
Occupational therapy involves activities in the approaches like neurodevelopmental therapy, sensory integration, and behavior therapy.
Neuro Developmental Therapy (NDT) –
NDT looks in the sensorimotor component of a child. NDT along with functional activities for the down syndrome works best.
If the child lacks the early developmental milestones, OT focuses on these areas. It includes-
Proper handling techniques
Facilitation of active movements and inhibition of unwanted movements.
Improve reach and grasp for functional play.
Weight bearing and weight shifting techniques.
Positioning and adaptive equipment.
Sensory Integration (SI)-
The down syndrome children may have sensory issues such as tactile, proprioceptive, vestibular/ balancing issues. Occupational therapist use principles of sensory integration to treat sensory issues.
Sensory integration approach helps the down syndrome child to regulate arousal level. It also improves the ability to attend the task.
The down syndrome kids may show stubbornness and haughtiness. They avoid some activity and through tantrums. Behavior strategies like positive or negative reinforcement can be applied to cut down their behavior issues.
The down syndrome kids may lack ADL skills and dependent on parents for daily routine tasks. Occupational therapist tries to make them independent as much as possible.
ADL board can be helpful to teach them ADL skills.
Occupational therapy activities for down syndrome children-
Gross Motor Activities-
Jumping on the trampoline.
Walking on the balance beam with or without support.
Balance board activity- ask him to clap up and down, front and back (for laterality concept and direction).
Ball catching-throwing while balancing on the balance board.
Ask him/her to grab an object from opposite side’s hand on bolster swing (midline crossing, reach out, core muscle activation).
Wheelbarrow walking to improves the strength of upper extremity.
Ladder (static/dynamic) climbing for eye-hand and hand-leg coordination.
Fine Motor Activities –
Theraband activities (Push-Pull).
Tongs for pre-scissors skills.
Paper cutting, pasting.
Tips for parents with Down’s syndrome child –
Down’s syndrome has no cure, but the medical complications associated with Down syndrome can be treated and managed. Treatment for Down syndrome is specific to an individual’s needs. So, it’s very important for parents to understand the basics of good parenting skill for handling a special child. Here we have mentioned few but important tips for parents.
#1 Accept the fact-
Accept the reality as it is. Your child has some disability- it might be physical or learning or any other. But having a disability does not mean he/she is a burden to the society. Acceptance of the fact will enable you to reach for a better and precise action. Never hide the fact, it’s never an embarrassment nor a curse.
Keep high degree of patience, conviction, and commitment. It takes years to bring the child up. It is an ongoing process, thus enjoy every bit of it. Next, leave no stone upturned, listen to all, try everything but take your own decision.
#2 Teach to love and be loved-
Children are innocent and calls for pure love. If you do not love your child, he/she will never love himself/herself. Spend quality time with your child.
#3 Be positive–
Some actors like Chris burke, Tommy Jessop, Lauren Potter in Hollywood movies have proved themselves. Children with down syndrome are the part of this world and do anything. Just they need some support from parents. So be positive and do your best for these kids.
#4 Involve them actively-
Involve them in a daily routine task. Help them initially and provide the cues if necessary.
#5 Identify talent and channelize it– Never thrust your wishes on the child. Encourage his/her strengths. Do not try to become the controller of his/her destiny. Remember the child is a differently abled child.
Be his/her friend, guide, and facilitator. Remember, every child is gifted with some talents. Identification of talents is difficult but necessary.
#6 Hide your stress-
Learn to hide your pressure and stress. Never let the child develop a feeling that the parents are in deep trouble. TRUST that no one else can be as focused for his/her welfare as his/her parents, so be cool and have energy for him/her always.
#7 Last but not the least – Never Give up.
Mark Batshaw. Children with disabilities.4th Maclennan+petty publication.
Maryanne Bruni. Fine motor skills for children with down syndrome: a guide for parents and professionals.(2016). 3rd Woodbine House publication.
Patricia Winders. Gross motor skills for children with down syndrome: a guide for parents and professionals.(2013). 2nd Woodbine House publication.
What is the Role of Occupational therapy in Autism and Autism Spectrum Disorders?
Occupational therapy plays important role in early intervention of autistic child, occupational therapy is a noble profession which works to promote, maintain, and develop the skills needed by the autistic kid to be functional in their respective home setting, community and beyond.
Pediatric occupational therapists use a holistic approach in planning treatment for each individual case of autism.
In a case of autism, the child finds it difficult to process and act upon information received through the sensory input creates challenges in performing everyday tasks. This can result in motor coordination difficulties, behavioral issues, cognitive impairment, anxiety, learning difficulty and more.
Before we go further, it’s better to understand the disorder and its features.
What is Autism?
Autism is a Neuro-developmental disorder by which we mean an impairment that occurs due to interference in the development and functioning of the brain during its formative phase. It mainly manifests as difficulties in three major areas of functioning of a child. These are social, communication, imaginative play areas in the child’s development.
Autism is a lifelong condition like cerebral palsy and mental retardation with varying degrees of severity and prognosis. It is also a disorder diagnosed by clinical observation and not by any lab tests.
Autism is a very complex, puzzling disorder to understand both parents and professionals working with these children.
Autism is not a single entity which is due to a single cause but represents a comprehensive diagnosis of the set of symptoms which varies from mild to severe. Hence, it is called as Autistic spectrum disorder (ASD).
Clinical features of Autism –
Autism is characterized by deficits in 4 areas of normal function-
Impairment in the development of social skills –
These children do not relate themselves to others, to objects and events around meaningfully. They have poor eye contact, they live in their own world, and they have difficulty in interacting with others.
Delayed and deviant language development and communication-
They have delayed speech, generally monosyllable or disyllable. Echolalia (repetition of sentences) is also common in these kids.
Stereotyped repetitive behavior and actions-
They are obsessed with their routine schedule. They show narrow range of interests. They lack imagination and pretend play, which makes learning difficult.
Abnormal response to sensory inputs-
Abnormal responses to sight, hearing, touch, pain, smell, and other sensory perceptions.
These features are spread over a wide spectrum and may vary with the child.
Whom should you approach for help?
Autism can be diagnosed as early as 9-14 months by a trained developmental pediatrician, developmental neurologist or child psychiatrist. It is diagnosed by a detailed history and clinical examination, which checks on certain criteria laid down by diagnostic manuals. Contact your child specialist, or psychologist or an occupational therapist for referral and help.
How autism or ASD child treated?-
Autism is not a disease which can be cured, but with early diagnosis and intervention, many of problematic symptoms can be controlled. The child can be helped to achieve functional ability and independence as per his ability so as to have an acceptable quality of life.
What does an occupational therapist do with Autism and autism spectrum disorder?
A pediatric occupational therapist provides their services to the autistic kids. The occupational therapist uses different functional approaches to control the behavior and inappropriate action.
Occupational therapist helps the autistic kids to participate in the activities of daily living (e.g. Feeding, dressing, toileting), educational activities, playing activities and social activities.
Occupational therapy services for the autistic child include assessment, intervention, and follow-up.
The occupational therapy evaluation and assessment process are designed to gain an understanding of the individual’s skill, his/her abilities, and disabilities.
Occupational therapist performs many standardized and non-standardized scale to assess the areas of dysfunction. Autistic kids don’t always cooperate and help the therapist to assess. More often, the therapist must rely on informal play observation, parent/teacher questionnaires to obtain information about the child’s developmental maturity, sensorimotor responses, and functional capabilities
Some screening tools can be used by the therapist –
Childhood autism rating scale (CARS)
Diagnostic criteria for autism spectrum disorder- DSM-IV
In short, Occupational therapist evaluate autistic kids in these areas-
Eye to eye contact, peer relationship, interaction with others etc.
Inadequate speech, Echolalia, non verbal communication etc.
Sensory seeking, sensory defensiveness, balancing issues etc.
Stereotypical behavior (hand flapping), avoid changes in schedules, commands following, etc.
Occupational therapy interventions for autism –
the occupational therapist provides interventions to help an individual respond to the information coming through the senses. Intervention plan may include sensory integration, motor developmental activities, and play activities to boost cognition and perception skills.
The two approaches most frequently used by occupational therapists are Sensory integration and Behavioral therapy.
Sensory Integration Therapy for autism-
Children with autism demonstrate a variety of sensory processing impairments and often show patterns of dysfunction similar to those of dyspraxic children. The therapist may use different activities so the child is able to register, modulate, and act on a sensory input.
Autistic children tend to lack the “inner drive” to master their environment. So, the therapist has to more imposing than is normally recommended for sensory integration therapy.
The occupational therapist uses different sensory strategies to promote self-regulation and motor planning.
Occupational therapy strategies based on sensory integration theory can help an autistic child to –
Regulate arousal level
Increase ability to attend and decrease distractibility
Behavior therapy also referred to as Behavior Modification. It is concerned with improving specific behaviors or skills through the structured manipulation of reinforcement. If the desired patterns of behavior are rewarded and undesired patterns of behavior are punished or ignored, behavior can be gradually modified by the therapist.
For better implication, the therapist identifies the reinforcers that are meaningful to the child and use it while correcting the undesired behavior. There are considerable pieces of evidence that behavioral therapy approaches can be effective in increasing communication and social competence in autistic kids (Werry, 1989; Howlin, 1987).
This formal explanation of therapy intervention is may be difficult to understand. Let’s have an example of an autistic kid and occupational therapy intervention.
Ryan, age 4 years, a boy with a diagnosis of Autism, referred to the occupational therapist for improvement in the functional motor, sensory problem, and self-care skills.
After evaluation, the problem areas were – an average intelligence, poor attention span, perseveration, resistance to transitions, lack of social interaction, delayed speech and tactile defensiveness.
Occupational therapist plan out the intervention after discussing the parents and their prime concerns.
Therapy session includes-
First, Ryan is welcomed to therapy by shaking hands or saying “hello”. Provide an attractive puzzle to him and promote its completion by using verbal behavioral strategies like clapping or saying “good job”.
Second, engaged him in an activity that provides firm touch or strong proprioceptive input in an effort to inhibit tactile defensiveness. For example, put him in between the two mats and squeeze it.
Third, engaged him in a play that promotes bilateral integration or mid-line crossing. Use positive reinforcement to avoid the repetitiveness of any activity.
Possible Outcomes- After 2 months of regular therapy, Ryan may show improvement in sensory defensiveness. He may cooperate with others; respond to welcome gestures, improved attention span during play.
Occupational therapy activities for autism-
Occupational therapist uses many activities to promote function and avoid the undesired behavior. These activities are endless and depend upon the creativity of the therapist.
Some proprioceptive and vestibular Sensory integration activities are-
Push, pull games like tug of war.
Play dough/ theraputty that offer high resistance.
Ropes or dynamic ladder climbing.
Sand play for tactile sensitivity.
Activities for ADL –
Group Activity to promote social interactions are-
Occupational therapy at home for autism-
Occupational therapy for the special kids always works with the parents or caretaker for better and effective treatment strategies. If the kid is having sensory processing issues, occupational therapist teaches parents about sensory diet (a planned and scheduled activity program).
Occupational therapist teaches parents how to initiate the therapy at home or how to conclude it. The OT also guides them which activities are preferable, and what types of toys should be brought.
Occupational therapist can also visit home for therapy. Therapy at home has its own importance, early intervention services may include home visits. An autistic child can better cooperate in the known environment instead of some new place. Because these kids are reluctant to break their routine.
The occupational therapist can also guide the parents to make home child proof because sometimes autistic kids may get hyper. Plus, the therapist can use basic materials for activities available in our houses. For example, dough & plastic clips- for fine motor activities, jump rope – for gross motor and coordination, coat and blazer – for ADL buttoning/unbuttoning. A therapist can use these materials as a therapeutic medium to enhance function.
Therapeutic activities which can be performed at home are endless. What I would like to suggest (as an OT) to the parents of an autistic child is, gain the knowledge about the purpose of activities, discuss it with your therapist, and ask him/her why he/she is using some specific games or activities. If the parents understand the reason behind it, so, they can apply it anywhere and with the available resources at home.
The role of occupational therapy in autism is to provide early therapeutic services to them. So, they can learn the concept of self, self-esteem, constructive play, and acceptable social behavior. The occupational therapist uses sensory integration, behavior techniques, group therapy to bring autistic kids in the mainstream.
American Occupational Therapy Association. (2010). The scope of occupational therapy services for individuals with an autism spectrum disorder across the life course. AJOT,64.
Ellen Yack, Shirley Sutton. Building bridges through sensory integration. 2nd Ed., Sensory resources LLC.
Bloomer, M. and Rose. Frames of Reference: guiding treatment for children with autism. Developmental Disabilities: A handbook for occupational therapists. The Haworth press.
The term Early Intervention indicates different meanings to different professionals. In this article, we are discussing Early Intervention related to the rehabilitation of a child and role of occupational therapy in early intervention.
Early refers to the critical period of a child’s development between birth and 3 years of age. Intervention refers to the treatment program designed to improve or maintain the child’s development.
Early intervention plan for kids is very effective for those children who are at high risk of developmental delay. The goal of early intervention is to prevent the physical, cognitive, social, emotional delay because of biological risk factor (low birth weight, fetal alcohol syndrome) or environmental risk factor (parental neglect, homelessness) in the young children.
Early Intervention Team-
Early intervention service is not limited to occupational therapy. Other professional also has their own role and importance. In early intervention, the role of family members is very important. Occupational therapist should collaborate with family and other professional for better service.
The team approach is used widely in early intervention. Professionals work together as a team to deliver the range of necessary services- medical aid, nursing care, physical therapy, occupational therapy, and speech therapy.
Role of Occupational therapy in Early Intervention –
Occupational therapy is considered as a primary service for the young children who needs early support. Occupational therapist assists in functional needs of the child.
The role of occupational therapist is to facilitate the independent functioning of infants and toddlers and their families. (Case-Smith, 1989)
Independent functioning of young children, according to their developmental age, is achieved through assessment and intervention effort in the areas of motor control, sensory modulation, adaptive coping, sensorimotor development, social-emotional development, daily living skills, and play. (Gorga, 1989)
Early Intervention and occupational therapy services-
In early intervention, occupational therapist plans out the initial assessment and set some objective and goals to achieve the desired outcome. After that, the Occupational therapist applies intervention strategies.
Occupational therapy Evaluation and Assessment-
The process of evaluation is the gathering and interpreting of information on the child’s age, health status, medical history, current developmental level of functioning, family support to maximize the child’s development.
Who are eligible for the early intervention services?
The early diagnosis of a child helps him/her to get early intervention services. Diagnosis includes cerebral palsy, Down ’s syndrome, ADHD, Autism, spina bifida are generally needed early intervention. But not limited to this, a child with developmental delay may be because of any genetic, chromosomal problem, neurologic problem, trauma is also needed early intervention.
The occupational therapist evaluates many developmental areas of child and point out the problematic area. In general, OT assesses the motor component, sensory component, perception, cognition, communication, social, and emotional aspects of the child.
The therapist may use informal assessment through observing the child playing with parents. More specifically, occupational therapist can choose from a variety of standardized assessment kit for better screening. Some are-
Bayley Scales of Infant Development
Erhardt developmental prehension assessment
The Hawaii Early Learning Profile(HELP);
The Assessment, Evaluation and Programming System for Infants and Children, Second Ed. (AEPS);
The OT assessment should identify the child’s current abilities, strength, and areas of need to attain desired developmental outcomes. Here, we have mentioned some of the important assessment areas –
Assessment of motor components-
Balance and co-ordination
Range of motion
Low sensory registration
Play with others
Goals and Objectives-
The occupational therapist on the early intervention team focuses on outcomes from a family-centered perspective. The goals should be focused on improvements in the gross motor skills and fine motor skills. The goals must be set after the discussion with the family member.
Occupational therapy Intervention-
Occupational therapists promote a child’s independence and self-confidence in their physical, emotional, and psychosocial development. Occupational therapy in early intervention is marked by engagement in meaningful occupations of the child and family in the natural environment.
Family centered approach –
In this approach, occupational therapist involves the family members in the intervention. The therapist guides the caretakers about the amount of involvement in child’s intervention program. Therapist can teach functional activities to the family members. Activities should be those that target behaviors and skills that the child can generalize to his or her daily routines at home, school, and community.
Activities should be those that target behaviors and skills that the child can generalize to his or her daily routines at home, school, and community. Therapist can provide support for families by listing to them, giving positive feedback regarding parenting skills.
Areas of Intervention-
The motor skills are more prominent and attract first preference in the treatment planning. The gross motor skills, such as independent sitting, standing, and walking come under the first priority. Along with this, fine motor skills including grasp and release of objects, in-hand manipulation has its own importance.
Occupational therapist must be creative when designing intervention strategies with caregivers.
baby on the knees with hand activities
Sensory Processing –
Occupational therapist addresses therapy planning if there is anything related to sensory processing problem. The infant or toddlers may be irritable, cry frequently, be difficult to comfort, or have difficulty with changes in routine.
The therapist may use appropriate tactile, vestibular, and proprioceptive input that elicits organized behavior and adaptive responses in the child.
kid on the platform swing
Occupational therapist promotes self-care in early intervention. Activities of daily living include feeding, dressing, toileting etc.
If self-care is restricted due to any motor or sensory issues, OT looks in that matter and guide the family member the right strategies. Many time modification of an environment is necessary for the adaptation. Assistive devices are also available, which help in feeding (modified spoon)
Occupational therapist assists in the refinement of the physical movement and mental abilities. Play is the perfect media OT uses to improve these areas. Play can be exploratory, creative, or competitive in nature. Therapist can teach a child gross motor and fine motor skills through play. The material (sand, plastic containers, spoons) typically found in the natural environment (home) should be the focus of play.
Occupational therapist prescribes equipment that allows maximum function to the needs one. Custom made adaptive seating devices have been found to improve sitting postures and eating skills of young children with multiple handicaps. A variety of adjustable seating inserts, wheelchairs are available in the market. Therapist guides the parent which is the best option available for the particular child and helps them to train him.
Occupational therapy is an integral part of early intervention team. Occupational therapists use holistic approaches with children and their main goal is to make them independent. Occupational therapy in early intervention program considers sensory, motor, social, and cognitive aspects of performance.