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Occupational therapy is the art and science of using meaningful and purposeful therapeutic activities to improve a person’s function across the lifespan.  Many people ask, ‘Why do children need occupational therapy when they do not have jobs?’ and the answer to that question is that children’s occupations include:

- Learning to self-regulate their state of arousal in order to have normal sleep/awake cycles and to attend appropriately to activities in their environment

- Development of motor skills to participate in life skills such as self care, play, and school performance

- Development of communication, social, and cognitive skills for participation in all environments

- Refinement of sensory processing in order to give meaning to environmental information and perform appropriate responses

Occupational therapists address psychological, social and environmental factors that can affect function.  They help children improve their cognitive, physical, and motor skills and enhance their self-esteem and sense of accomplishment.  An OT’s education includes the study of anatomy, kinesiology, neurology, pediatrics, human development across the life span, physical dysfunction, and psychology.  

OT's specialize in activity analysis allowing them to use play and work activities to increase functional skill development.  In pediatrics the child's inner drive is also used to guide treatment and care is taken to provide the child with the "just right challenge" to encourage development without frustration.

2.  What does an pediatric OT session look like?

Most sessions at Playful Development begin with time in the sensory motor gym working on the specific needs of the child related to strengthening, coordination, and sensory processing.  Activities involving sensory processing include tactile activities, muscle activities, and movement activities often from suspended equipment (various swings).  Visual skills and auditory input are also a big part of each treatment session.  The child is given opportunities to participate in activities that challenge their ability to respond appropriately to sensory activities, by making an organized response.  Activities are child driven because active involvement and exploration enable the child to become more mature and effecient in their organization of sensory information.  But what treatment actually looks like - is just plain fun!  After time in the sensory motor gym, the child is usually transitioned to the fine motor room to work on their fine motor needs (visual motor, perceptual motor, self care, or handwriting) or oral motor needs.  The session is often ended with a calm activity.

3. What is Sensory Processing?

The theory of sensory integration was developed by A. Jean Ayres, PhD, OTR, FAOTA, who made the discovery that some children had a disorder that resulted in inefficient organization of sensory input received by the nervous system.  She developed diagnostic tools for identifying the disorder and proposed a therapeutic approach that transformed pediatric occupational therapy.

Sensory processing is a term that refers to the way the nervous system receives sensory messages, processes the messages within the brain, and turns them into responses.

Sights, sounds, touch, taste, and smell are the senses we are most familiar with.  Two less familiar sensory sources come from proprioception and vestibular senses.  These two senses give us our perception of speed, movement, pressure on our joints and muscles, and the position of our bodies.

Dr. Ayres described sensory integration as “the organization of sensation for use”.

Sensations provide the body with information about the environment.

The information is organized within the brain to provide the body with the appropriate response.

Effective sensory processing leads to successful adaptive responses.

Sensory processing is a dynamic process that is gathered from a multiple of sensory processes and over time the body builds on feedback.

Children have an inner drive to seek out sensory input from their environment.

Experience helps processing and becomes memory and allows for more complexity.


4.  What is expected of typically developing children?

Birth to 6 months:

-      Babies begin with reflexive movements that develop into more purposeful movements
-      Development of a voluntary grasp
-      Development of head control against gravity leading to neck and trunk stability
-      Improvement of visual attention & tracking: look at their hands & follow moving objects
-      Lying on stomach leads to weight bearing on extended forearms & hands 
-      Learn to sit and balance in sitting
-      Touch is also essential in development
-      Auditory orientation is also developing during this age
 

6 – 12 Months:

-      Develop bilateral control in the form of crawling, creeping, and pulling to stand
-      Refine their fine motor grasp to a neat pincer (tip of thumb and index finger)
-      Begin to cross midline of their body to reach for objects, develop rotation in their trunk
-      Hold objects and begin to use tools, begin to gain information about how much force
-      Increase their movement and exploration of the environment
-      Begin to understand space around them
-      Search out toys

1 – 2 years:

-      Can now walk
-      Interested in interacting and moving
-      Begin to gain body awareness – moving around objects rather than bumping into them
-      Begin to talk and interact
-      Understand and follow directions
-      Exert independence
-      Increase complexity of their play
-      Increase creativity
-      Increase their tactile discrimination which enables purposeful interaction with toys

3 – 7 years:

-      Plan for and sequence more complex gross motor movements
-      Increase their cognition and language skills
-      Can rely more on auditory skills than visual skills
-      Increased ability to use tools in refined ways (utensils, writing, scissors)
-      Complete self-care such as dressing themselves including fasteners
-      Increase self-help such as opening containers
-      Increase in fine motor manipulation

5. What are the basic needs of sensory motor development?

An enriched sensory environment is crucial to human development.

Motor development is dependent on sensory processing, and the feedback from movement leads to improved sensory processing.

Babies need weight bearing in prone (on their stomach) for developing palmer arches and shoulder stability, that will later affect tool use.

Children need to move to develop balance, body awareness, and spatial relations skills.

Deprivation of sensory input early on may affect motor milestones, tolerance for sensory input, development of social/emotional and cognitive skills that come with interactions.

6. How to identify a sensory processing disorder?

Each child presents with a puzzle to be solved, however there are some clusters of behavior seen. 

A child may experience sensory modulation disorder and demonstrate over-responsiveness (over sensitivities or defensiveness), or they may demonstrate under-responsiveness, or sensory seeking or craving of sensory information.  For some children they will demonstrate a combination of over and under responsiveness, or their responses may vary.

There may be a sensory based motor disorder in which the child demonstrates dyspraxia or poor motor planning, and appears clumsy and uncoordinated.  Children with a sensory based motor disorder often have poor muscle tone, fatigue easily, and demonstrate poor core strength.

For more information and detailed checklists regarding sensory processing disorders may be found on line through the following website:  www.spdfoundation.net   then click on Red Flags