Pediatric Occupational Therapy

What is Pediatric Occupational Therapy?
Occupational therapy addresses a child’s ability to function in the everyday tasks that someone of the same age typically encounters.  For younger children, this may be learning to play with toddler toys, drinking from a bottle, and rolling over.  A pre-school child’s daily tasks are about learning to dress themselves, feed themselves, and play with other children.  As children get older, occupational therapy ensures that they can function as independently as possible in all their self care tasks as well as during the school day.  OT may address a child’s needs through developmental activities, fine motor tasks, sensory integration, visual motor tasks, gross motor play, or other skill based tasks.

Our Pediatric Occupational Therapists (OT) work with children and infants who have problems in cognitive functions, movement and coordination.  These young patients could be living with a wide range of conditions such as neurological complaints, orthopedic injuries, spinal cord damage, muscular dystrophy or other motor disorders.

The work of pediatric occupational therapist involves analyzing and treating skeletal, neuromuscular or cognitive restrictions of their young patients and helping them in developing their interaction and communication skills, refinement of motor skills and educating them in self-care abilities, especially for the older children.  Most of the patients are too young to understand verbal instructions, so games are often incorporated in the therapy.  This will help to engage their interest and cooperation.  It is imperative to have the commitment and support of the family as well.

Occupational Therapy Treatments

Activities of daily living (ADL) are the basic daily activities one does to be independent.  These activities include things such as bathing, dressing, eating, grooming, transferring to and from bed or chair, toileting, ambulation, shopping, cooking and housework.
Fine motor (FM) skills are important to ensure proper development.  It is an important component of development in infants and children to practice fine motor skills for functional use of hands.  Examples of FM activities are: shoe tying, manipulating small objects such as buttons, zipping and unzipping, using scissors, pinching, opening and closing objects, handwriting, grasping items and being able to isolate finger movements to push buttons or type.
Play is a vital part of a child’s learning.  If milestones are not met, it can signal to medical professionals and parents a more serious problem, or the need for further investigation to identify the underlying cause of the delay.  Often times, the first signals of motor skill, sensory or cognitive delays present themselves as delayed milestones.  It is important to address these delays as soon as they are identified to prevent secondary impairments or compensatory movements that may lead to further motor, sensory, behavioral or cognitive delays.

Occupational therapists address these delays during treatment utilizing play activities where the child may not realize they are working on skill development.  As occupational therapists, our goal in all treatments is to find meaningful and purposeful activities that motivate the child to reach their full potential.

Due to medical complications, many of our patients do not develop oral skills required to coordinate sucking and oral exploration during early development.  A lack of oral skills development often leads to difficulties in oral feeding.  We work with feeding on all levels from enteral to oral feeds.  Some children are not born with feeding issues, but develop feeding problems as a result of NICU hospitalizations, sensory impairments, sensory-motor impairments or failure to thrive.  These children may have oral aversion, limited food choices, poor appetite, poor intake or weight gain.  After an extensive evaluation, the best-individualized treatment approach is chosen and implemented.
Handwriting Without Tears® is a program that evaluates and treats the child as a whole when looking at handwriting.  Handwriting problems may include difficulty with letter formation, letter spacing and sizing.  These problems are commonly addressed in occupational therapy by determining the underlying causes of poor handwriting or frustration with handwriting.  During a handwriting evaluation, it is important to consider a pediatric patient’s visual-perceptual and visual-motor skills as well as ensure that the child has all of the pre-writing skills necessary to be successful with handwriting. Go to www.hwtears.com for more information.
Kinesio Taping® involves the use of a special elastic therapeutic tape that is applied to the skin over a specific muscle or joint.  This taping method is very different than traditional taping methods that often involve rigid tape.  It is Kinesiotapes elastic properties that encourage use of weakened muscle groups and improve circulation.  In the pediatric population, Kinesiotape can be used for a variety of purposes, but its most common use is to encourage the use of proper muscles to perform specific movements over a period of time.  Increased use of a weakened muscle improves strength and the quality of movement improves.  Other therapeutic uses for Kinesiotape include pain management, edema (swelling) management and joint/tendon stabilization. Go to kinesiotaping.com for more information.
NDT is the primary treatment technique for individuals with central nervous system impairment such as children with cerebral palsy or traumatic brain injury.  NDT trained therapists believe that due to the central nervous system impairment, atypical posture and movement patterns are used by the child for function.  Unfortunately, it is the use of these patterns that lead to secondary impairments and dysfunction.  NDT trained therapists use clinical thinking to evaluate a person’s movement in order to determine the focus of each physical, occupational or speech therapy session.  Therapeutic handling is used to assist in the facilitation of typical movement to gain function.
Oral-motor patterns must be directly observed.  The individual presents many different patterns at once with varying degrees of severity and skill, making identification of baseline oral motor skills challenging for the therapist.  Different patterns may be observed with different food types and in response to different types of stimuli.
Sensory Integration involves a trained therapist who generally works with the child in a room specifically designed to stimulate and challenge all of the senses.  During the session, the therapist works closely with the child to encourage movement within the room.  The therapy is driven by four main principles: the Just Right Challenge (the child must be able to meet the challenges through playful activities), Adaptive Response (the child adapts behavior to meet the challenges presented), Engagement (the child will want to participate because the activities are fun) and Child-directed (the child’s preferred activities are used in the session).

Our sensory system is the way we perceive the world around us, and if our sensory system is not working properly it affects us negatively.  Anyone can have sensory dysfunction.  Our senses include touch, hearing sight, taste, smell, gravity, joint and muscle movement.  Sensory Integration is a neurological process that provides us with the ability to combine all of these senses and enables us to appropriately interact with people and the environment.  Sensory integration is a part of normal development for most children through plan and everyday activities.  In children who lack the integration, we see development delays, learning deficits, feeding difficulties and behavior problems.  These deficits may occur due to their inability to process sensory information appropriately.  Sensory integration is frequently utilized as a treatment for sensory issues in child autism.

Sensory integration therapy is careful to not provide children with more sensory stimulation than they can cope with.  The therapist looks for signs of distress.  Children with lower sensitivity (hyposensitivity) may be exposed to strong sensations, while children with heightened sensitivity (hypersensitivity) may be exposed to quieter activities.  Treats and rewards may be used to encourage children to tolerate activities they would normally avoid.

TheraTogs are an exo-muscular system for neuromotor postural and sensory training.  The suit is worn under the patient’s clothes for up to 16 hours a day and provides the patient with body awareness, bone and joint development, sensory input, assists with stability issues, provides joint alignment and assists with motor performance. Go to theratogs.com for more information
Visual Perception refers to the brain’s ability to make sense of what the eyes see.  This is not the same as the term visual acuities, which means how clearly a person sees (i.e. “20/20 vision”).  A person can have 20/20 vision and still have problems with visual perceptual processing.  Good visual perceptual skills are needed for reading, writing, cutting, drawing and completing math problems as well as many other skills.  A child who has problems with perceptual processing might have difficulties working puzzles, copying block designs or discriminating shapes, pictures or letters.

Seven “sub-areas” under the term visual perception include visual discrimination, visual memory, visual spatial relationships, visual form constancy, visual sequential memory, visual figure ground and visual closure.  It is important to note that visual perceptual deficits cannot be remediated with practice.  Therapeutic activities are designed to help children compensate for visual perceptual deficits and assist them to capitalize on their visual perceptual strengths.  If you suspect your child has a visual perceptual processing problem, you should request an evaluation by a trained professional such as an occupational therapist.

Assessments include the non-motor test of visual perceptual skills, motor free visual perception test and Beery Test of visual perception (a sub-test of the Beery Test of Visual Motor Integration).

The PPHC Approach

The commitment of PPHC is to provide high quality, outcome-oriented healthcare to patients requiring specialized pediatric rehabilitation services in the home. This commitment is shared by every employee of PPHC as we strive daily for clinical excellence, high standards of patient care, partnerships with our families and communities, and ongoing therapy education.

By providing Physical, Occupational and Speech Therapy we are able to provide a valuable multidisciplinary approach that serves all the child’s therapy needs. In addition, consistent collaboration with doctors and community healthcare providers widen our ability to care for the children further. Frequent communication and cooperation with a child’s school is also taken into consideration as we provide the most thorough care possible to meet each child’s goals.

Our hope is to set goals with the patient and family and do everything we can to help a child reach their personal best. The family is a key component in optimizing therapy outcomes. We want all of our families to feel that they are involved and knowledgeable about the therapy and care their children are receiving, because help and follow through at home can make a world of difference in the effectiveness of therapy.

With caregiver collaboration and family centered treatment, we provide a level of excellence in therapy that we are proud to share with you.