The Occupational Therapy Assessment
When a child is referred for an Occupational Therapy Assessment, the presenting problem might be one or a combination of the following:
- Poorly developed dominance;
- Poor pencil control and cutting;
- Poor sitting posture/ inability to sit still and focus;
- Reduced visual perceptual skills for age;
- Incorrect letter and number formation;
- Reversals of numbers or letters;
- Poor ability to modulate his or her system or activity;
- Sensitivity to loud noises, certain clothing textures and unstable surfaces, height or movement;
- Overwhelmed in crowds or busy spaces;
- Clumsy or accident prone.
These are the most common presenting problems, but the list is not exhaustive. All or some of these challenges can significantly hamper progress as school socially and academically. An Occupational Therapy Assessment can identify the areas that need specific support.
SENSORY MODULATION: Sensory Modulation refers to the capacity to regulate and organise the degree, intensity, and nature of responses to sensory input in a graded and adaptive manner. This allows the individual to achieve and maintain an optimal range of performance and to adapt to challenges in daily life. It involves the Vestibular-Proprioceptive System. Proprioception is the perception of joint and body movement as well as position of the body in space. The Vestibular system is our sense of movement and gravity. The vestibular receptors are in the inner ear and provide the brain with information as to the position of the head in space, monitor acceleration and deceleration and have an important role to play in the automatic postural system. The vestibular system tells us if we are moving, in what direction, and whether or not we are upright. It also signals to us when our balance is threatened and thus provides us with a sense of safety. Further, a child must respond appropriately to things seen, touched, heard and tasted.
MOTOR PERFORMANCE: Motor Performance includes Postural Control as well as Balance and Equilibrium Reactions. Postural control provides the stability and the background against which movement can take place. This is the ability to achieve and maintain good posture against gravity. It involves the development and balance of flexion and extension throughout the body in dynamic and static positions. Central control includes stability and control specifically of the trunk, hip and shoulder girdles to allow co-ordination of the limbs. Balance is the ability to stay upright and in control of body movement. It requires postural adjustments of the whole body.
MOTOR CO-ORDINATION: Motor Planning, Gross and Fine Motor Co-Ordination are all assessed in an Occupational Therapy Assessment. Motor planning is the ability to plan and organise a series of intentional motor actions in response to environmental demands. This involves having an idea of what to do, planning the steps and executing the action. Gross motor co-ordination refers to the control and co-ordination of large muscle groups. The majority of gross motor tasks involve bilateral motor co-ordination, which is the coordination of both sides of the body during symmetrical, alternating or asymmetrical tasks. Fine Motor Co-ordination refers to the control and co-ordination of small muscle groups in the hands for precise movements. The pencil grip is usually evaluated first as this influences the pencil control and fine motor output of the child. For a good pencil grip, a stable trunk and shoulder girdle are required, as well as adequate strength of muscles in the hand. Tasks like cutting involve both bilateral integration and fine motor co-ordination.
DOMINANCE AND BILATERAL INTEGRATION: This is the development of preference in the upper limbs, lower limbs and eyes. When a child’s dominance is not yet established, he or she may have poor bilateral integration skills (the ability to co-ordinate the two sides of the body and cross the imaginary “midline”). Bilateral integration is necessary for efficiency in tasks like cutting, threading, star jumps, reading, writing, ball skills and sport. When a child’s dominance is no:
EYE PURSUIT AND TRACKING: Eye movements play an important role in reading, visual perception and copying tasks in the school classroom. Occupational Therapists do not test eyesight but do not test eyes’ movements and the ability of a child to establish and maintain visual contact with a target. The tests involve assessing the eye’s ability to follow an object through the visual field, the ability to converge, the eyes’ ability to move through the mid-line and the quick localization of a moving object. A referral to a Developmental Optometrist may be necessary of difficulties are found.
BODY AWARENESS: This is the awareness of the body in space.
VISUAL PERCEPTION: Visual perception is the ability to interpret or give meaning to what is seen. Visual perceptual skills relate to the ability to understand and interpret symbols, shapes, numbers and letters. Firstly, an informal assessment of basic concepts like: shape, number, colour identification and naming; body concept including the naming of parts of the body; ability of the child to write his/her own name. Information from the parent and teacher is important in this regard and would be added to the assessment findings.
INTEGRATION AND MOTOR OUTPUT:
Directionality: Directionality is the projecting of all directions from the body out into space (right and left, up and down, forwards and backwards).
Visual-Motor Integration: Visual motor integration involves the integration of visual perceptual skills with fine motor co-ordination. This subtest consists of copying a series of geometrical lines and shapes.