What is Occupational Therapy?



Any activity either mental or physical, medically prescribed and professionally guided to aid a patient in recovery from disease or injury. The therapeutic use of self care, work and play activities to increase independent function and enhanced development. The educational background of Occupational Therapist includes extensive course work in anatomy, neurology and psychology. Their education also includes course work in activity analysis. This enables the therapist to analyse the components of play and work activities, choosing tasks that will improve the child's basic skills.


What can I do as a concerned parent?



Contact your primary care physician (GP), and discuss Occupational Therapy services for your child. Referrals can also come from your Speech Therapist (ST), Physio (PT), or Child Psychologist (PSY).


How we can help



Occupational Therapists are trained to assist people in performing functional tasks that normally occupy their lives. The "occupation" of a child is to develop the skills necessary to become functional, and independent adults.

These skills include:

1. Regulation of arousal level in order to participate in everyday activities.

2. Refinement of sensory discrimination and processing.

3. Continual refinement and development of gross and fine motor skills.

4. Development of communication skills.

5. Appropriate social interactions.

6. Cognitive skills.

7. Age appropriate self care skills.

8. Self concept.

The expectations for the level of development of any of these skills will vary depending on the child's age. It is critical to remember that all of these skills are developing simultaneously. Impairment of one area, is likely to delay development in other areas. Play is the medium most often used in the Occupational Therapist's treatment of children. It is a natural and highly motivating method to treat children. Education and involvement of the family is a primary consideration, and may be critical to success.



Tips for Organizing Your Child’s Toys



De-clutter first

Thinning out your kids’ collection of toys is rarely a fun task, no matter their age. The process for doing so is the same one for de-cluttering anything around your home: • Decide if it’s enjoyed, useful, or meaningful, it’s enough to keep. • If not, and it’s in good condition, donate it to charity so other children can find as much joy in the toy as your child once did. • If it’s not in good shape, discard it. Then it’s time to organize what’s left. Here are some great ideas to help:

1. Store small toys in see-thru bags Tip: Store game instructions in the bag so they don’t get lost. For puzzles, tuck a photo of the complete puzzle in the bag, so kids know what the final result should look like. I like the zip-lock type baggies, because also teaches your child to open and close the bags by sliding the plastic piece that sits on top of the bag.

2. Use Rolling Open-Bin Carts or whatever you already purchased. Tip: Label the bins for older children, or attach photos for younger children. This helps teach the kids about clean-up, and lets them know where toys should go.

3. Use bungee cords or laundry baskets to corral stuffed animals Tip: This would work wonderfully to hold basketballs, footballs, and other sporting equipment as well!

4. Use Wall Space Look at an IKEA catalogue or webpage. Ikea has wonderful shelving and storage products that will spark ideas and meet your needs.

5. Other tips Toys can also be organized by age. K-mart and Big W have their toys listed in age order. I recommend using that as a reference. Donate infant toys if they are in good shape. Toys for older children that are to be handed down from siblings can be stored until ready for them. Set expectations: Your child is not too young and is capable of picking up their toys. They should be putting them away when done playing with them. You will have to insist on it at first, but then they will get used it. To begin, have the older children help by modelling the behaviour you want.



Toy Story
I was interviewed in a featured story for ADVANCE, written by Jessica La Grossa. November 2005.



A child's occupation is play—it is his time to discover the world around him and how to be a part of it. And pediatric occupational therapists know that the best therapeutic approach to their clients is quite simple: get down on the floor and play! But what toys are best to promote this natural occupation in children? Which toys can best facilitate beneficial, therapeutic play for the child's development? ADVANCE recently spoke to experts in the field to aid in your next trip to the toy store. Oldies but Goodies According to Sue Schwartz, PhD, author of The New Language of Toys, some of the classic toys that have been around for several years are still the most useful ones for therapy. "My all time favorite is the Fisher Price® farm," she told ADVANCE. Schwartz explained that because children tend to be interested in farm animals, this toy gives them the opportunity to articulate the various animal sounds such as "moo" for a cow, etc. Children can also practice fine-motor skills by manipulating the animals' actions, such as making the horse gallop, etc. Toy animals also represent their living counterparts, and children can identify with them emotionally, helping mommy horse take care of baby horse, for instance. "This toy has stood the test of time," Schwartz said. She also finds the old fashioned, multi-colored stacking barrels that fit inside each other to be excellent toys for therapeutic play. "It is such a simple toy, and cheap," she said. "[Therapists] can have the children follow directions such as 'get the smaller one' and 'which goes where?'" Schwartz explained. "The physical movement of turning, stacking and putting the barrels into each other is a [beneficial] activity." Donna Neidlinger, OTR/L, has extensive experience working with children as a therapist at Children's Specialized Hospital in Hamilton, NJ, and through her private practice in Mercer County, NJ. Above and beyond, her favorite oldie but goodie is Play-Doh®. "It serves not only to strengthen little hands, but it can be used as a sensory modality and as a learning tool," she shared. "It is versatile, inexpensive and travels well." Other classic recommendations by Neidlinger include balls, jump ropes, crayons, chalk, bubbles, stacking cups, puzzles, stacking rings, beads, lacing boards, balloons, coloring books, Matchbox™ cars and dolls. Be Creative According to Neidlinger, therapists must rely on their own creativity in order to find multiple ways to use the same toy. Schwartz agreed, saying that toys such as the farm mentioned above generally speak for themselves, but added that less obvious toys can be more difficult to work with. "You know what to do with a toy such as the farm, but the barrels, for example, may take a little more creativity because they are so simple." However, Neidlinger finds that a plus. "The toy itself should be simple—[so you can] let the child be creative with it," she said. "Then you can follow their lead." Brian Arnone, MHSA, administrator of Pediatric Potentials Rehab, Inc. in Longwood, FL, and co-owner of Rehabtoys.com, explained that most toys come with suggestions for use right on the packaging. "Children are truly the experts, though, in finding different ways to use all of our toys and products," he added. How to Choose Toys First and foremost on your mind when shopping for toys should be safety. "Don't choose anything with sharp edges," warned Schwartz. "Also, be aware of the pieces—if they are too small, they can be swallowed." Not only should your client's safety be of concern, said Schwartz, but also any younger siblings who may be present during treatment. "If you are working with a four-year-old, you can use a Lite-Brite, but what about the little brother?" she asked. Next, Neidlinger recommended, make sure that the toy can serve several therapeutic functions. Schwartz suggests asking yourself what you can get out of the toy. Don't be pulled in by high-tech toys which leave little room for varied play through creativity. "Some of the bells-and-whistles toys don't offer as much of an opportunity for communication," Schwartz pointed out. "They do all the talking and interaction for the child." Durability, added Arnone, is also important in choosing toys. Neidlinger agreed, adding, "They should be able to take 100 washings and still look great." "Toys that are made of fabric and difficult to wash in a clinic are better for individuals to use at home," said Arnone. Neidlinger also reminded ADVANCE that the toys therapists purchase need to travel well, since many OTs make home visits. "And, if the playthings break, they should be inexpensive to replace," she said. Arnone said it's imperative that products bought in a toy store be purchased based on clients' needs. "Some children need stimulating toys with a lot of bright colors and music," he explained. "Other children need calming toys that are less visually exciting and more soothing, such as our vibration-based toys or calming CDs." "Shop carefully," advised Schwartz. "It's not price but quality that makes a toy good." Land of Make Believe "Play is children's work," Schwartz told ADVANCE. "But children should never think they are working." Therefore, while therapists should always have goals in mind, they should simply focus on allowing the child to make believe and play during treatment. "It's not necessary to let the child know that their toys are being used as therapeutic tools," added Neidlinger. "It's stigmatizing, if they understand." "It is always best to guide children in play activities," explained Arnone. "It's never as much fun to be told what to play or do." In rare cases, however, Arnone pointed out, it can be best to tell an extremely bright child why you are using specific toys. "These children are more likely to try to avoid some types of play/therapeutic activities due to fear of failure or discomfort in trying something new," he explained. "If this approach is necessary to get a child to cooperate, the explanation should still be explained in a fun and positive way." In the end, said Neidlinger, the most important thing is to be in the moment with the child during play. "Always make it fun and exciting," she urged. Jessica LaGrossa is ADVANCE associate editor. She can be reached at jlagrossa@merion.com.


Common terms



AUDITORY- Relating to the sense of hearing.

ATTENTION - Attention is a complex behaviour that requires the integration of several areas of the brain. The first component of attention is "registration", our initial awareness of a change in sensory stimuli. The second component of attention is "orienting", an increase in our level of alertness. The final component is involves "effort" or exploration of the stimulus. For example, our effort might be to listen to or watch the stimulus.

BILATERAL INTEGRATION - Refers to the ability to use the two sides of the body together in a coordinated manner. Examples of bilateral tasks include: running, skipping and jumping with both feet together.

COORDINATION - Includes both motor control and praxis (motor planning). Motor control is the ability to move with precision and smooth quality. Praxis is defined below.

CO-REGULATION - The ability to access a person's regulation state and create an equalising response.

DYSPRAXIA - Difficulty in planning, sequencing, or carrying out (motor planning) unfamiliar actions in a skilful manner.

EXECUTION - Actually doing the activity or executing the action.

FINE MOTOR CONTROL - Involves development of manipulation skills in the hands to eventually allow for efficient and precise manipulation of objects. Sensory motor skills must be well developed for this to occur, including postural control, sensory modulation and praxis.

GUSTATORY - Relating to the sense of taste.

HYPERSENSITIVITY - Over sensitivity to sensory information. May present as being fearful, cautious, negative or defiant.

HYPOSENSITIVITY - Under sensitivity to sensory information. May present as craving intense sensory information, withdrawal, or difficulty to engage.

IDEATION - The thought or idea. Planning an idea in your mind the ability to visualise an activity.

INTEGRATION - Being able to bring together sensory motor functions in a useful, functional level of performance.

INTEROCEPTION - This sense has only been recently added as the eighth sensory system. Inputs from this system let us know when we need to eat, drink, go to the toilet. It also tells us that we feel ill, excited or nervous.

MODULATION - The brains regulation of it's own activity. The ability of the nervous system to filter out, or let in sensory information.

MUSCLE TONE - This refers to the tension in a muscle. Muscle tone should be high enough to hold a position against gravity, yet low enough to move a body joint through its full range of motion. Abnormal muscle tone would be either extreme tension or lack of tension in a muscle.

OLFACTORY - Relating to the sense of smell.

POSTURAL CONTROL - Refers to the ability to sustain the necessary background posture to efficiently carry out a skilled task, such as reading or handwriting. The ability to stabilise the trunk and neck underlies the ability to develop efficient eye and hand movements.

PRAXIS - This is the medical term used to describe motor planning. It is defined by Dr. A. Jean Ayres as "The ability of the brain to conceive of, organise and carry out a sequence of unfamiliar actions." Inadequate praxis, Apraxia, is often a symptom of inadequate sensory processing. Long term problems noted in children with apraxia, include: clumsiness, difficulty performing motor tasks at age level, difficulty following directions and imitating movement. A child with apraxia may need extra practice and instruction to learn a new motor task. Once he learns something, he may refuse to try it another way and appear "stubborn".

PRIMITIVE REFLEXES - There are movement reflexes that each baby is born with. These "primitive" reflexes assist the infant in successfully progressing through various stages of movement so they may learn to roll, crawl, sit and walk, etc. As a child matures, these the child is able to move without the need of these reflexes and they become more integrated and do not predominate or direct movement patterns. Sometimes a reflex continues to direct or dominant movement after an age where it is normally integrated. We would consider this an abnormal reflex pattern.

PROPRIOCEPTION - This is information that the brain receives from our muscles and joints to make us aware of body position and body movement. Proprioceptive makes a strong contribution to praxis, to the child's ability to grade movement and to postural control.

REGISTRATION - The ability for the body to register that sensation has occurred.
SELF REGULATION - Refers to the ability to attain, maintain and change your level of arousal appropriately for a task or situation. Arousal is considered a state of the nervous system and describes how alert someone feels. To attend, concentrate and perform tasks according to situational demands, the nervous system must be in an optimal state of arousal (or alertness) for the particular task. Adults use a variety of subtle sensory techniques to maintain their arousal level.

SENSORY DIET - The multi-sensory experiences that one normally seeks to satisfy the sensory appetite.

SENSORY INTEGRATION - The ongoing process of the central nervous system to receive, interpret, combine, and respond to sensory information in order to perform purposeful activity. The organisation of sensations for use. Our senses give us information about the physical conditions of our body and the environment around us. "Sensations flow into the brain like streams flowing into a lake." ...."The brain must organise all of these sensations if a person is to move and learn and behave normally.

SENSORY MODULATION - The ability to regulate our responses in a manner proportional to the sensory stimuli. There are children who have an increased level of arousal and seem to be over responsive to sensory input. This is described as sensory defensiveness. Children at the other end of the spectrum have a decreased level of arousal and seem to be under responsive to sensory input. This is referred to as sensory dormancy. Both extremes of modulation may be seen in one child to the same type of stimuli, but generally, one extreme tends to dominate. Both, cause the child to have difficulty with allocation of attention and interfere with the development of sensory processing skills.

SENSORY PROCESSING - The ability to interpret the information that the brain receives.
SEQUENCING - Making a plan for an action. Identifying the steps for an activity.

TACTILE - This refers to our sense of touch. Deep pressure and light touch receptors. The sense of touch is a child's first way to learn about the external world. It is a critical sense to developing relationships with primary care givers and to giving comfort. The sense of touch plays a very important role in the child's development of body awareness, and is critical in the development of praxis (motor planning).
VESTIBULAR - This refers to the sense of movement and balance. This is the sense that allows us to recognise how we are moving in relationship to gravity. Receptors in our ears sense if we are upright, upside down, moving sideways, spinning, etc. As a result of this sensory input, we make adjustments to posture and to our eye movements. Vestibular sensation has a strong impact not only on posture and eye movements, but also on: balance, coordination of the two body sides, and emotional control. Accurate vestibular processing is essential for the development of praxis.

VISUAL MOTOR SKILLS - Refers to the development of smooth and efficient eye movements to allow for tracking of objects, focusing on specific targets and shifting gaze from one object to another.

VISUAL PERCEPTION - Refers to the brain's ability to interpret and make sense of visual images seen by the eyes.



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