The OT Lens
The OT Lens Author: Krista Flack, MS OTR/L
Occupational therapy can be a very broad field, and can sometimes ‘overlap’ with other professionals, like speech and physical therapists, or even ABA therapists, special education teachers, and psychologists. This week I want to discuss how an occupational therapist looks at some issues through their unique lens. I’ve chosen 3 specific areas to dive deeper into:
Handwriting is a topic that instantly comes to mind when many people think of occupational therapists. It is true that we do work on handwriting with many children, especially in the school setting. Occupational therapists first evaluate what is causing difficulty with handwriting. When you sit down to write, there are many functions going on, requiring different skills areas. Adequate fine motor skills, which include strength, coordination, and pressure grading, are necessary to control the pencil to move it in the right ways. Visual perceptual and ocular motor skills are necessary to see the lines on the paper, space words and letters appropriately, and shift your focus between what you are copying and the paper you are writing on. Sensory processing, attention, and executive functioning skills help us to hold the idea in our head while writing, remember what the letters should look like, and regulate our arousal level to maintain focus on our task rather than becoming distracted by other sensory input. Knowing where the deficit lies helps us to determine what underlying skills need to develop before expecting handwriting to improve significantly 2
Eating is a complex process, but once proficient at it, it is easy to forget how complex it was to begin with. Taking a single bite can require up to 32 steps, from using utensils to tolerating smells to coordinating lip, tongue, and jaw movements. A single swallow requires coordination of 26 muscles, 6 cranial nerves, and all 8 sensory systems. Occupational therapy can help to strengthen muscles and improve coordination of movements in the mouth, improve awareness in the mouth to better detect where food is and where it needs to go, increase tolerance for tastes and textures that are not preferred, and improve self-feeding skills, like drinking from a cup or using a fork.
As on occupational therapist, I have learned that negative “behaviors” are often symptoms of an underlying problem. Some of those underlying problems could be motor delays (it’s frustrating when you can’t do something expected of you!), language delays (how do you follow directions and rules if you didn’t understand them?), poor sensory processing (it’s hard to listen to what the teacher says when you need to move, or when you can’t ignore the lights buzzing, the child next to you tapping his pencil, or the smell of the teacher’s perfume), poor self-regulation (transitions and changes in the routine can cause anxiety and therefore meltdowns), and poor attention and executive functioning (planning, organizing, and initiating tasks can be so difficult, that it is just easier to refuse to do them). Attempting to use a behavioral method without first addressing these underlying deficits will likely be met with frustration and resistance. After addressing the underlying skills through occupational therapy, a behavioral approach can then be used more successfully.