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WHAT IS OCCUPATIONAL THERAPY

The World Federation of Occupational Therapy (WFOT) defines occupational therapy as:
"A healthcare profession based on the knowledge that purposeful activity can promote health and well-being in all aspects of daily life. The aims are to promote, develop, restore, and maintain abilities needed to cope with daily activities to prevent dysfunction"

WHAT IS OCCUPATIONAL THERAPY FOR CHILDREN?

Occupational therapists view the child, the child's environment, and the interaction between the child and the environment in a holistic way. The dynamic nature of this interaction is created by the child's continual development, maturation and learning. The environment is also continually evolving and changing.

WHAT ARE THE DOMAINS OF PAEDIATRIC OCCUPATIONAL THERAPY?

The occupational therapist is concerned with analyzing the child's ability to perform in everyday contexts. Occupational therapists hold two broad goals for the children they serve. These goals are to improve the child's functional performance and to enhance the child's ability to interact within his or her physical and social environments.

WHAT ARE THE SKILLS THAT THE OCCUPATIONAL THERAPIST ASSESSES?

The underlying skills that an occupational therapist is concerned with are:

● Sensorimotor components include sensory and perceptual processing, neuromuscular abilities, and motor skills
● Motor components refer to gross, fine and oral motor skills
● Cognitive components underlie the child's ability to perceive, attend, and learn from the environmen
● Psychosocial skills refer to the child's underlying abilities to interact with others, to cope with new or difficult situations, and to manage his or
her behaviours in socially appropriate ways.

WHAT ARE THE PERFORMANCE AREAS WHEN WORKING WITH CHILDREN?

The performance areas that the occupational therapist is concerned with are:

● Self-care: refers to physical daily living skills. These include feeding and eating, grooming and hygiene, dressing, and functional mobility
● Play and leisure: refer to skills and performance of intrinsically motivating activities, spontaneous enjoyment, and self-expression
● School: skills in this area refer to reading, writing, math, and higher level problem solving and cognitive skills.

WHAT IS SENSORY INTEGRATION?

In 1989 sensory integration was defined as "the neurobiological process that organises sensation from one's own body and from the environment and makes it possible to use the body effectively within the environment. The spatial and temporal aspects of inputs from different sensory modalities are interpreted, associated, and unified. Sensory integration is information processing" (Ayers, 1989; p.9).

WHAT IS SENSORY MODULATION?

Modulation of sensory input is critical to our ability to engage in daily life activities. Filtering of sensations and attending to those that are relevant and attending attention to task requires a good level of sensory modulation (Lane, 2002). When modulation is inadequate, the child's attention may be continually diverted to ongoing changes in the environment and this may interfere with learning and play. Current research is examining the Sensory Modulation Disorder (SMD) as a valid clinical syndrome (Miller et al. 2007) 

WHAT IS PRAXIS?

Under the light of sensory integration theory, praxis is viewed as a uniquely human skill that enables the brain to conceptualise, organise, and direct purposeful interactions with the world (Ayres, 1985). Praxis includes knowing what to do as well as how to do it and is fundamental for skills such as getting dressed, learning to write, or playing.

The ability for praxis includes 3 components (Ayres, 1989)

● Ideation - knowing what to do
● Motor planning - directing and organising the movement
● Execution - carrying out the motor plan

WHAT IS SENSORY PROCESSING DISORDER?

For most children, sensory integration develops in the course of ordinary childhood activities. But for some children, sensory integration does not develop as efficiently as it should. When the process of sensory integration is disordered, a number of problems in learning, development, and/ or behaviour may become evident (Sensory Integration International, 1991).

Sensory Processing Disorder (SPD) manifests itself in two major ways: poor praxis and poor modulation (Bundy & Murray, 2002).

WHAT ARE THE COMMON SIGNS OF SENSORY PROCESSING DISORDER?

● Hyperactivity and distractibility
● Delays in speech and language
● Low muscle tone and coordination problems
● Slow development of motor skills
● Poor organisation of behaviour
● Learning difficulties at school
● Sensitivity to movement, touch, sights, sounds, and smells
● Poor organisation skills in adolescence

WHAT ARE THE SIGNS OF SENSORY PROCESSING DISORDER – DYSPRAXIA?

● Clumsiness
● Difficulty planning and organising the sequences of movements in activities such as cutting with scissors or riding a bicycle
● Difficulty with daily activities such as getting dressed, using knife and fork
● Tendency to bump into and/ or trip over things
● Taking longer to learn skills such as tying shoelaces, writing letters or numbers, catching a ball
● Poor gross motor control when running, climbing, jumping, and going up and down stairs
● Doing things in inefficient ways
● Low self-esteem
● Difficulty when transitioning from one activity to another

WHAT ARE THE SIGNS OF SENSORY PROCESSING DISORDER – POOR MODULATION? (SENSORY MODULATION DISORDER)

● Aversion or struggle when picked up, hugged, or cuddled
● Aversion to certain daily life activities, including baths or showers, cutting of fingernails, haircuts, face washing and dental work
● Responding with aggression to light or unexpected touch to arms, face, legs
● Avoidance of certain styles or textures of clothing (e.g. scratchy)
● Avoidance of play activities that involve body contact
● Dislike getting hands in sand, finger-paint, paste
● Exaggerated fear of falling or heights
● Become anxious when feet leave the ground
● Seem particularly slow at movements
● Avoid jumping down from higher surfaces
● Avoid climbing, escalators, or elevators
● Seem to misunderstand what is said
● Have difficulty looking and listening at the same time
● Seem distracted if there is a lot of noise around
● Hold hands over ears
● Gag easily with food in mouth
● Picky eater
● Mouth objects
● Express discomfort with light
● Rock unconsciously
● Become overly excitable during movement activities
● Be "on the go"
● Be slower than others to respond to sensation

WHAT ARE THE COMORBIDITIES WITH SENSORY PROSSENING DISORDER?

Sensory Processing Disorder (SPD) may exist on its own, or it may coexist with:
● Attention Deficit and Hyperactivity Disorder (ADHD)
● Asperger's Syndrome
● Fragile X Syndrome
● Autistic Spectrum Disorder (ASD)
● Pervasive Developmental Disorder (PDD)
● Cerebral Palsy (CP)
● Spina Bifida
● Nonverbal Learning Disorder (NLD)

WHAT IS SENSORY INTEGRATION TREATMENT?

"Therapy involving therapeutic sensory experiences...can be more effective than drugs, psychological analysis, or rewards and punishment in helping the brain and body to develop optimally"

During Sensory Integration Therapy, the child is guided through activities that challenge his or her ability to respond appropriately to sensory input by making a successful organised response (SII, 1991). Therapy takes place in a safe and interesting environment and through the use of specialised suspended equipment the child is afforded the opportunity to integrate sensations arising from the vestibular, proprioceptive, tactile, visual, and auditory systems. Treatment is developed in collaboration with the child and aims at meeting the child's specific needs for development. The activities are also designed to elicit autonomic responses and are graded to lead to higher levels of organisation that will promote the child's interaction with the environment. Specific skills training is not part of sensory integration treatment, rather activities are used to help the child develop the underlying abilities that are necessary for learning and mastering of skills.

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