OCCUPATIONAL THERAPY M.ARUN KUMAR., B.O.T., OCCUPATIONAL THERAPIST MERF Institute of Speech and Hearing

Now imagine this... have you had a shower, had lunch with friends, Take a moment to think of some of the things (occupations) you have done today... have you had a shower, had lunch with friends, or gone to work? Before we start talking about Occupational Therapy I want to give you guys something to think about… Now imagine this...

HOW WOULD YOU… HAVE A SHOWER IF… You had poor balance? You couldn’t reach your arms up to your hair? Maybe an OT would… Recommend a seat for you to sit on. Work on activities to work on your balance. Install grab bars etc. to ensure safety. Standing vs. sitting Imagine not being able to wash your hair. Maybe an OT would help you.. work on strengthening your arms Look at other ways to wash your hair (resting arms on counter)

HAVE LUNCH WITH FRIENDS IF… HOW WOULD YOU… HAVE LUNCH WITH FRIENDS IF… You couldn’t hold a fork? You couldn’t remember where to meet them? You just couldn’t cope with getting out of bed? Maybe an OT would… Help you to regain movement and strength Recommend a special fork One handed-how will you use a knife? Memory strategies for events. Practice trials in community. Write out directions checklist to follow. One to one or group to focus on coping skills

HOW WOULD YOU… GO TO WORK IF… You had pain in your back? You heard voices in your head? You had arthritis in your hands? May do a GRTW Modify duties New ways to lift things Ergonomic assessment Can they return to work? Strategies to overcome _____________ Pain management Adapting to a bigger grasp Modify the work area Splint for pain relief

Is the assessment and treatment of OCCUPATIONAL THERAPY Is the assessment and treatment of physical and psychiatric conditions, using specific purposeful activity to prevent disability and promote independent function in all aspect of daily life.

Who do Occupational Therapists work with? Children Seniors Adolescents Adults

Where do Occupational Therapists work? Hospitals Schools Mental Health Facilities Home Care Personal Care Homes Private Clinics Rehabilitation Centers Community Health Centers Insurance Companies Client Homes Client Work Places

Occupational Therapists are concerned with: Person, Environment Occupation Interactions

POPULATION HEALTH OCCUPATION OP ENVIRONMENT PERSON

HUMANS AS OCCUPATIONAL BEINGS – PEOP MODEL PERSON (Intrinsic Factors) ENVIRONMENT (Extrinsic Factors) OCCUPATION Social Support Physiological Social & Economic Systems Cognitive PERFORMANCE Occupational Performance & Participation Spiritual Culture & Values Built Environments & Technology Neurobehavioral Psychological Natural Environments WELL BEING QUALITY OF LIFE

OCCUPATIONAL THERAPY SERVICES FOR INFANTS AND CHILDREN Pediatric occupational therapy is skilled treatment aimed to enable the child to be as physically psychologically and socially independent as possible.

HOW DO THEY WORK Occupational therapists works in close partnership with…. Medical Team Educational Team Community Team Family Together they have a shared responsibility for meeting children’s needs.

MULTIPLE DISABILITY When child has several different disabilities we say, that He/She has multiple disability Multiplication of disability 50% cerebral palsy – visual deficit 13% cerebral palsy – auditory deficit Mental retardation

SOME EXAMPLES OF MULTIPLE DISABILITIES ARE: Deafblind (Visual impairment + hearing impairment) Visual impairment + hearing impairment + mental retardation. Visual impairment + mental retardation. Cerebral palsy + mental retardation / hearing / speech / visual problems.

Hearing / Listening Vision / Looking Touch Smell Taste Movement Sensory integration Cognitive Social

GROSS MOTOR SKILLS: Movement of the large muscles in the arms, and legs. Abilities like Rolling Crawling Walking Running Jumping Hopping Skipping

FINE MOTOR SKILLS: Movement and dexterity of the small muscles in the hand and fingers. Abilities like In-hand manipulation Reaching Carrying Shifting small objects

SENSORY INTEGRATION Sensory processing Ability like Vestibular Proprioceptive Tactile Visual Auditory Gustatory Olfactory skills

CENTRAL NERVOUS SYSTEM Academic Intellect Learning cognition Daily Living Behavior Activities Auditory Visual- Attention Perceptual Language Special Center Development Skills Perception Functions Motor Ocular Postural Eye-hand Motor Adjustment Coordination Control Development Sensory Body Reflex Ability to Scheme Motor Maturity Screen Input Academic Postural Awareness of Motor Security Two Sides of Body Planning Systems Sensory Olfactory Visual Auditory Gustatory Tactile Vestibular Proprioception CENTRAL NERVOUS SYSTEM

COGNITIVE PERCEPTUAL SKILLS: Abilities like Attention Concentration Memory Thinking Reasoning Problem solving Concept of shape Size and color

VISUAL MOTOR SKILLS: Perception of visual information Abilities like copying MOTOR PLANNING SKILLS: Ability to Plan Implement Sequence motor tasks.

ORAL MOTOR SKILLS: Movement of muscles in the Mouth Lips Tongue Jaw Sucking Biting Chewing Blowing Licking

PLAY SKILLS: Age appropriate purposeful play skills SOCIO-EMOTIONAL SKILLS: Ability to interact with peers and others.

ACTIVITIES OF DAILY LIVING: Self – care skills like daily Dressing Feeding Bathing Grooming Toilet tasks

ENVIRONMENT MANIPULATION Like handling Switches Door knobs Phones TV remote

HUMANS AS OCCUPATIONAL BEINGS – PEOP MODEL CHILD (Intrinsic Factors) ENVIRONMENT (Extrinsic Factors) OCCUPATION Social Support Physiological Social & Economic Systems Cognitive PERFORMANCE Occupational Performance & Participation Spiritual Culture & Values Built Environments & Technology Neurobehavioral Psychological Natural Environments WELL BEING QUALITY OF LIFE

Case Example Profoundly deaf, identified at 11 months Developmental history of hypotonia, tactile defensiveness, motor overflow, poor eye contact. Slow learning rate, limited social interaction with peers Referred by preschool teacher

On observation Reduced proprioceptive perception Weak bilateral coordination and motor planning Reduce proximal trunk stability Avoidance of crossing midline

Therapy Implementation Successive approximation based on motor complexity Increase visual and perceptual skill Model matching side by side Facilitate midline crossing Guidance and support of motor plan

Influence of sensory integration procedures on language development. Ayres AJ, Mailloux Z. Am J Occup Ther. 1981 Jun;35(6):383-90 The relationship between language development and sensory integration was explored through single case experimental studies of one female and three male aphasic children ranging in age from 4 years, 0 months to 5 years, 3 months. Three of the four children had received either speech therapy, special education specific to aphasia, or both, before starting occupational therapy. Inspection of rate of language growth before and after starting occupational therapy showed a consistent increase in rate of growth in language comprehensive concomitant with occupational therapy compared to previous growth rate.

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