Occupational Therapy

Occupational therapists focus on assessing and developing an individual’s ability to function day-to-day to their highest level in normal daily activities at home, in school, out in public, and at work. The goal is to foster independence, productivity, and self-care. Occupational therapists will help a person improve strength, dexterity, and coordination while performing tasks, but they will also assist in decision-making, abstract reasoning, problem solving, perception, memory, sequencing, and more.

What is occupational therapy?

Occupational therapy (OT) is an integral part of a Cerebral Palsy patient’s overall treatment program. The goal of occupational therapy is to promote a child’s ability to perform daily rituals and activities in a way that will enhance their quality of life and make possible the enjoyment of independent living.

During occupational therapy, a trained therapist will guide the individual in adapting, compensating, and achieving maximum function levels. They take into account physical functioning abilities and limitations, cognitive functioning levels (i.e., reasoning and processing skills), emotional needs and desires, and ability and willingness to adapt and compensate. The existing home environment and support system play an important role, as well.

Occupational therapy is a form of therapeutic intervention. The goal of therapy is to ensure a child achieves the highest level of functional performance within their home, school, public and work environments. Occupational therapy employs adaptive processes to teach a child to perform tasks required in the normal course of a day.

This is accomplished by focusing on:

• Identifying adaptive methods a child can learn to complete tasks
• Breaking down essential tasks into smaller, do-able steps, often modified
• Capitalizing on the need for accomplishment, pride, enjoyment and independence
• Developing in a child a sense of place in their environment, at school, and in the community

Everyday tasks – the ones an occupational therapist will focus on – can test a child’s physical and emotional resources. These tasks include:

Home:

• Eating
• Dressing
• Personal grooming
• Brushing teeth
• Bathing
• Writing
• Grasping objects
• Playing
• Using a computer
• Using a telephone
• Interacting with family and caregivers
• Preparing food
• Housekeeping
• Using adaptive equipment or assistive technologies

School:

• Opening doors
• Sitting at a table or desk
• Handwriting
• Using the bathroom
• Traveling on the bus or in a vehicle
• Opening a locker
• Holding, reading books and supplies
• Avoiding or overcoming physical obstacles
• Interacting with teachers, aides and peers
• Taking part in school activities
• Completing assignments, homework

Work:

• Using a phone
• Using tools related to specific vocations
• Using computers
• Interpersonal skills
• Job skills

Community:

• Navigating public spaces
• Using public transportation
• Driving
• Shopping
• Interacting with service personnel
• Identifying and using community-based resources

Who benefits from occupational therapy?

Occupational therapy can have far reaching, positive consequences for the individual with Cerebral Palsy, his or her parents, and caregivers.

Individuals with Cerebral Palsy benefit from therapy because it teaches a child how to develop and maintain a daily routine – which contributes to independence and quality of life. As children grow, they want to handle everyday tasks to the best of their abilities without assistance or interference. They want to be accepted by their peers and participate socially with others. They would prefer not to be reliant on others for their basic needs.

Additionally, occupational therapy enables a child to respond to life’s demands, setting the stage for him or her to develop relationships, care for themselves, provide for their own physical needs, pursue education, maintain employment, and achieve economic parity with their peers.

What a child learns in occupational therapy is put into practice in their daily rituals, from the time they wake up in the morning to get ready to go to therapy or school, finishing homework, playing with siblings, to putting on their pajamas for a good night’s sleep.

The benefits for children are:

• Developing a workable routine
• Adapting to abilities, not limitations
• Pursue interests, hobbies, activities
• Interacting with others
• Being part of a community
• Performing tasks independently
• Responding to the demands of everyday life
• Perceiving the importance of tasks
• Developing critical thinking skills
• Coping with challenges and emotions
• Learning to adapt and compensate

Children with severe cases of Cerebral Palsy can also benefit from occupational therapy; mostly through the use of specialized adaptive equipment and assistive technologies. In this circumstance, an occupational therapist will modify, then teach children how to use specialized equipment, including:

• Rotating desks
• Computers with pre-programmed language (if they are unable to speak)
• Equipment to navigate transfers from a laying to seated position
• Custom carpentry to meet a child’s needs
• Computerized environmental control systems
• Specialized chairs that help maintain proper position for eating, breathing

Parents/Caregivers

From the time a child is diagnosed with Cerebral Palsy, parents worry about their child’s quality of life, their ability to function, their health, their emotional status, their ability to be accepted and their future prospects. Occupational therapy can help quell some of those fears by fostering skills that will allow their child to play, interact with others, go to school, navigate the community and be productive within the workforce. Once the child masters skills within their own unique skill sets, parents will feel less overwhelmed by their child’s condition.

The benefits for parents and caregivers include:

• Reduced stress
• Opportunity to see child thrive emotionally
• Security in knowing a child can perform tasks safely
• Observing the child form relationships

Parents and caregivers also benefit from occupational therapy. The benefits include:

• Decreased reliance on others for help with self-care
• Increased physical mobility
• Decreased need for assistance with everyday tasks (dressing, grooming, eating)
• Less physical stress from assisting a child with mobility
• Decreased emotional dependence
• Diminished frustration for the child

When is occupational therapy advised?

Occupational therapy is based on a child’s needs and can be recommended any time after a child is diagnosed with Cerebral Palsy. A referral to an occupational therapist will be made when a child demonstrates to members of the child’s medical team that assistance with everyday tasks is needed.

Every case of Cerebral Palsy in unique. A comprehensive assessment of an individual’s motor skills, cognitive functioning, developmental condition, overall environment and physical and psychological needs will determine therapy goals.

What happens during occupational therapy?

Occupational therapy begins with an assessment of a child’s physical and mental functioning, both of which figure prominently in a child’s ability to perform a task. The therapist will pay special attention to:

Physical:

• Range of motion
• Flexibility
• Muscle and hand-eye coordination
• Reflexes
• Strength/weakness
• Developmental issues
• Object manipulation
• Transitionary movement

Visual:

• Visual clarity
• Visual perception
• Visual tracking
• Visual memory
• Spatial perception

Sensory:

• Auditory ability
• Body awareness and perception
• Tactile response
• Memory sequencing
• Proprioceptive
• Vestibular

Psychological/Social:

• Temperament
• Ability to relate to others
• Capacity for reason
• State of mind
• Propensity to set goals

External factors:

• Home environment
• Potential obstacles that could modify the course of therapy
• The role of the child in the family
• The makeup of the child’s family
• Socio-economic status of the family
• Cultural practices

As a professional that is cast in the role of implementing treatment that takes into account all of these factors, the occupational therapist must ask several questions as part of his or her assessment. Some of the questions may not immediately seem relevant to a parent, but they are essential to the therapist’s ability to develop workable solutions for the child.

Some of the issues an occupational therapist will consider are:

• Community a child lives in
• Size of his or her family
• Family’s work obligations
• Availability of community and government resources

Once an assessment is completed, the occupational therapist will implement the treatment plan. At this time, the therapist will teach children how to complete tasks using several paced steps, using adaptations when necessary, and teaching them to compensate if required in order to complete a task or activity successfully.

Further, the therapist will use exercises that will help the child understand the nature of the task and why it’s important. This is vitally important because a child must not only be able to approach and complete a task, but also understand the benefit of the task and have a desire to perform it.

To meet that end, a plan of treatment for occupational THERAPY must encourage:

• Personal empowerment
• Motivation
• Coping skills
• Understanding of the tasks
• Decision-making capabilities
• Perception
• Recall and memory
• Self-assessment strategies
• Problem solving
• Critical thinking
• Planning skills
• Understanding cause and effect

Occupational therapists will also use some physical exercises to assist a child as they relate to tasks, including those that encourage dexterity, flexibility, and hand-eye coordination. Additionally, interventions such as biofeedback and relaxation may also be employed to treat anxiety in a child that becomes overwhelmed while learning.

During therapy, the therapist will also determine what, if any, assistive technologies should be used to adapt limitations. The child, and his or her parents or caregivers, will be trained in the use and maintenance of equipment.

Assistive technologies may include, but are not limited to:

• Computers
• Voice-synthesizers
• Bars that a child can grip
• Modified household supplies
• Bathing seats
• Dressing devices
• Walkers
• Orthotics

Parents should expect that they will be an active participant in their child’s treatment. The occupational therapist should use their skills to teach parents as much about their child’s abilities as possible; parental involvement and support at all levels of Cerebral Palsy treatment is an essential component to a child’s ability to overcome their limitations. Additionally, parents must reinforce in home what is learned in occupational therapy, so it becomes part of a child’s daily routine.

Where does occupational therapy take place?

Occupational therapy will typically take place at any one of several facilities:

• Schools
• Outpatient clinics
• Inpatient rehabilitation centers
• Hospitals
• Skilled nursing centers
• A child’s home

Parents must also be prepared to assist a child in the home setting. The occupational therapist will instruct the parent on how to complete exercises at home.

Additionally, a child’s condition, his or her plan of treatment and insurance coverage will likely play a role in how often a child will attend occupational therapy in a clinic setting, at home, or at school.

Who provides occupational therapy?

Occupational therapy services are provided by trained, licensed occupational therapists, often assisted by occupational therapy assistants.

Professionals engaged in the practice of occupational therapy are highly-skilled. It’s necessary that they understand the complex relationship between a patient’s physical condition, cognitive functioning, and psychological condition. To treat a child, a therapist must be able to assess a child in the context of the environment in which they live. They must understand how a child perceives their impairment.

Further, an occupational therapist must be able to factor in external issues such as a child’s level of support at home, and even a family’s economic status, when devising a plan of treatment that will bring improved functionality to a child.

According to the American Occupational Therapy Association, therapists typically practice in one of more subspecialties, including:

• Children and youth
• Mental health
• Rehabilitation and disability
• Work and industry
• Aging
• Health and wellness

Educational requirements to practice occupational therapy are consistent across states; a therapist must hold a master’s degree or higher to enter the field. Candidates must successfully complete an educational program that is accredited by the Council for Occupational Therapy Education to pursue licensure.

Occupational therapy coursework is made up of several subjects, including:

• Biology
• Chemistry
• Health
• Anatomy/physiology
• Social sciences
• Human development
• Behavioral sciences
• Psychology

Additionally, all states regulate the practice of occupational therapy, though licensure requirements can vary. Some states also allow practitioners to apply for a temporary license while they seek full licensure. To obtain licensure, all applicants must:

• Graduate from an accredited program
• Complete fieldwork requirements
• Pass the National Board for Certification in Occupational Therapy examination
• Apply for a state license

Occupational therapists will often work with an assistant. Occupational therapy assistants typically will have completed an associate’s degree in occupational therapy. According to the U.S. Bureau of Labor Statistics, the first year of such a program is comprised of classroom study that focuses on science, health and human development. The second year is largely made up of field work.

Assistants are also required to pursue licensure to practice in most states; some states require the national exam and other administer their own exam.

Parents with questions or concerns can obtain information about licensing requirements by visiting their state’s licensing board website.