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Abstract
Occupational therapy is not expected to ”cure” multiple disorders. Rather, occupational therapy aims to improve health and quality of life by engaging the child in meaningful and impor¬tant occupations. To accomplish this with a child who has problems, the occupational ther¬apist may aim to improve functions through direct remediation or to minimize the effects of the problems by teaching compensatory skills and coping strategies to the child, parents, and teachers. Often, remediation and compensatory approaches are thought¬fully combined in an intervention plan that is tailored to the particular needs of the child and family.
Role of occupational therapy in activity of daily living:
We presented a wide range of options for enhancing ADLs and IADLs for children and adolescents with disabilities. Typical developmental sequences and special methods for evaluating ADLs and IADLs were presented. The environmental context in which ADLs and IADLs occur, the child’s capacities, and the demands of the task, as well as parent and child preferences, were discussed in the planning of evaluation and intervention. Performance skills during an activity and performance patterns were noted as influences on the outcomes of intervention. Intervention strategies were illustrated, including task adaptation, assistive technology, and environmental modification. The importance of positioning and orienting the child to the work surface was stressed. As technology changes and outcome data become avail¬able, a responsibility of the occupational therapist is to remain knowledgeable about current methods and equipment that promote independent functioning in children with disabilities (Shapherd, 2005).
Role of occupational therapy with sensory integration disorders:
Sensory integration is defined as “the organization of sensory information for use” (Ayres, 1972). We typically think of five senses; vision, hearing, smell, taste and touch. These senses give us information about the world around us, and how we are interacting with our environment. There are also some internal senses (Heller, 2002):
The position of different parts of our bodies (proprioception).
How our bodies are moving (kinesthesia).
Our position in space and in relation to gravity (vestibular).
Bundy et al., (2002) presented a taxonomic model that sensory integrative problems fall into four general categories:
• Sensory modulation problems
• Sensory discrimination and perception problems
• Vestibular - proprioceptive problems
• Praxis problems
These disorders are accompanied with autism, ADHD & learning disabilities
Intervention:
Intervention is continually planned and evaluated in relation to the occupations that the child wants and needs to do in the contexts of home, school, and community (Roley, 2002). The assessment process aids the therapist in deciding whether any intervention is recommended and, if so, in what format: individual therapy, group sessions, collaborative problem solving with parents and teachers, or consultation (Parham & Mailloux, 2005).
Role of occupational therapy in hearing disorder:
Occupational therapy assessment emphasizes how the child’s development and function are affected by loss of hearing sense. General intervention goals have been presented, stressing provision of activities and experiences that allow the child to develop adaptive behaviors. Brief explanations of specialized techniques used with these children have also been provided, including the use of hearing aids, cochlear implants and sign language. Occupational therapists use their knowledge of adaptation, task and activity analysis, and developmental sequence to help children who has hearing impairments engage in meaningful and purposeful occupations.
Role of Occupational Therapy after Stroke:
Three broad approaches in occupational ther¬apy intervention for activities of daily living were discussed: compensation, restoration, and education. We discussed the necessity of establishing target outcomes for activity perform-ance that address
Before selecting intervention strategies, however ’the practitioner must determine the appropriate intervention approach for each client. Several approaches are available to select from, and they may be used singly or in combina¬tion. Because of the complexity of human behavior, the evaluations of ADL and in¬strumental activities of daily living (IADL) are described relative to four parameters (Rogers & Holm, 2003):
1. Value of the activity to the client.
2. Level of independence in performing the task.
3. Safety of activity performance.
4. Adequacy of task performance involving difficulty, pain, fatigue and dyspnea, duration (efficiency), societal standards, satisfaction, experience, resources, and aberrant task behaviors.
Other factors influencing target outcomes and choice of intervention approaches were also presented, in¬cluding the client’s ability to learn, the client’s prognosis, the time allocated for intervention, the client’s discharge disposi¬tion, and the client’s ability to follow through with new rou¬tines or techniques.
Role of Occupational Therapy In Swallowing Disorders:
Dysphagia occurs in three types: paralytic, pseudobulbar, mechanical, in children and adult.
Once the clinical evaluation is complete, recommendations and a plan are formulated (Avery-Smith, 2003).
Intervention to adults:
Once consideration in treatment, it is remedial versus compensatory goals. Goals may be remedial, and then change to compensatory once a plateau in function is reached (Logemann, 1998).
Another consideration is the type of therapeutic techniques used. Indirect therapy addresses the prerequisite abilities or the capacity to swallow without ingestion of food or liquid. Direct therapy rehabilitates prerequisite abilities or the capacity to swallow during therapeutic snacks or meals (Avery-Smith, 2003).
These therapeutics techniques are done with the following steps:
• Progression of diet with swallowing therapy (Avery-Smith, 2003).
• Gradation dysphagia diets (Groher, 1987).
• Patient and caregiver training (Avery-Smith, 2003).
Intervention to children:
Intervention for swallowing dysfunction relates specifically to the child’s unique strengths and limitations as shown in the evaluation. The following techniques were outlined by (Glass and Wolf, 1998):
1. Increase initiation of swallowing
2. Improve oral transit
3. Handling and intervention during feeding
4. Modify the infant’s food
5. Mealtime participation
Role of Occupational Therapy In Feeding Problems
There are three problems causing feeding disorders:
Sensory problems as in: Autism, BDMH, sensory integration disorder and multiple disabilities.
Oral hypersensitivity can relate to any one of three causative factors (Wolf & Glass, 1992):
1. Oral hypersensitivity is often associated with the early experiences of the child (i.e., as a newborn and young infant) (Bazyk, 1990).
2. Hypersensitivity also may result in the child who is not fed by mouth for an extended period (Tarbell & Allaire. 2002).
3. A neurologic impairment that directly affects the sensory tracts can also cause oral-sensory defen¬siveness
The intervention programs through three steps:
1) Activities in between mealtimes
2) Activities to prepare for eating
3) Mealtime interventions
Disorders in oral motor performance as in: BDMH.
Children with hypertonicity differ from children with low muscle tone who exhibit delayed oral motor patterns that are observed in children who are younger. The following are examples of oral motor patterns observed in children with hypertonicity ( Smith & Humphry, 2005):
• Tonic bite.
• Tongue thrust.
• Lip retraction and lip pursing.
Intervention:
a. .Postural alignment: Improving the child’s postural alignment and stability through good positioning is often helpful in promoting oral motor function (Schwarz ,2003).
b. Characteristics of feeding positions and positioning device (Smith & Humphry, 2005).
c. Handling techniques in support of oral movement (Morris & Klein, 2000).
• Preparation for Children with Hypotonicity.
• Preparation for Children with Hypertonicity
• Techniques during Feeding
• Cheek Support.
• Arm support.
• Spoon Placement.
• Head positioning.
Oral structure problems as in: Cleft lip & cleft palate
Children with oral structural problems at birth may have feeding problems that directly relate to the structural deficits, and a compensation strategy is indicated. Two structural problems that can occur are cleft lip and palate. These problems often create feeding difficulties, particularly in the postnatal period (Emondson & Reinhartsen, 1998). The role of the occupational therapist is to make recommendations for feeding equipment, adapted methods, and positions to be used until the child undergoes plastic surgery or outgrows the structural problem (Humphry & Morrow, 1998).