fitzjohns presentation[1]

From Beanbags to Letter Formation: The Planning,

Implementation, and Review of My First OT Sessions

Alissa BonjuklianAlissa Bonjuklian

1/4/20091/4/2009

Role of OT

In general practice:– Increase participation in ADL’s and other meaningful

occupation In community paediatrics:

– Based on an understanding of the interactions among children, their activities, and their environments

– Interventions should either: Establish a higher level of functioning Compensate for activity limitations through adaptation and/or

assistive technology Modify environments Change systems to increase participation (Case-Smith, 2001, p.3)

– Goal = help children cope with disability and master activities that have meaning to them

* denotes name change

Intro to John*

6 y.o. Globally delayed:

– Cognitive developmental delays– Physical/gross & fine motor problems– Perceptual impairments– Speech difficulties

These impairments all hinder him from keeping up with his classmates and being able to perform important daily activities

Role of OT in treating John

– Occupational performance of children = self-care, work, and play activities

Work academic tasks & functional tasks– examples– “The functional skill of handwriting supports the academic task of

writing and allows students to convey information” (Case-Smith, 2001, p.545)

– Role of OT = view the student’s handwriting performance by focusing on the interaction of the student, the school environment, and the school occupation (Case-Smith, p.546)

– John’s treatment plan falls under the first category of interventions: “Establish a higher level of functioning”

RESEARCHING

Reflected on my 1st observation

Used resources at FBS & Greenland Rd for Rx ideas, games, worksheets, props etc.

Read through HWT teacher’s manual

Used Lindsay as a resource for more in-depth info task analysis

Integrated the ideas learned through research with my observations of John and his needs

Thought about the different activity ideas from the resources I used and arranged them in a flowing order that would be most effective

Spent time creating the props I needed (laminated mazes, worksheets, games, etc…)

PLANNING

Task Analysis of Handwriting: Performance Components

Sensorimotor components Sensory

– Tactile/proprioceptive– Visual perceptual skills*– Kinesthesia– Position in space– Visual closure

Neuromuscular– Muscle tone– Strength*– Postural control

Motor– Crossing the midline*– Bilateral integration Bilateral sequencing skills– Laterality– Praxis– Fine motor coordination*– Visual motor integration*

Cognitive components Attending to a writing task independently Recalling letter formations and handwriting strategies over time* Generalising handwriting from an intervention program to real-life situations

Psychosocial components The child’s values and interests, self-regulation, self-concept, and coping skills(Case-Smith, 2001, p.553)

Week 1: Hand & Finger Strengthening

Newspaper tear & crush Thumb wrestle Elastic band activities Playdough work

– Hid toys in Playdough and ask him to find them– Rolled it out to make a “pizza”– Made a “snake”– Made the letter ‘C’ and other simple letters

Mazes HWT slate

Week 1 Results

Carried out the strengthening activities relatively well Vaguely recognized letters that were taught to him last

week indicates problems with letter recall When asked to write the letter ‘C’, he drew:

instead of

This indicated that he may have trouble crossing the midline

Week 2: Bilateral Activities

Big clapping sequences Arm circles w/ and w/o beanbags lazy 8s Reached around body to grab another beanbag Playdough work

– Made 2 “snakes” cross them over each other to make an ‘X’. Run his fingers over it.

– Drew an ‘X’ into patted-down Playdough. HWT slate Mazes Flag-making

Week 2 Results

Much improvement as a result of the bilateral activities:– Recalled letters more easily– Wrote the letter ‘C’ correctly– Receptive to learning the letter ‘X’

Continued to write very lightly indicated more need of strengthening exercises

Week 2 Results: Flag-Making

Week 3: Perceptual & VMI Activities (with a Touch of Bilateral & Strengthening!)

Bilateral Warm-Up– Beanbag activities

Arm circles figure 8’s Reached around body to grab beanbags

– Rolling object back and forth Visual Perceptual Activities

– Visual fixation/tracking activity: had him follow a moving beanbag first with his head then only with his eyes

– Visual memory exercise: started with 5 letter cards and take 2, then 3 away– Figure discrimination: overlapping worksheet– Visual discrimination matrix cards

Visual Motor Integration– Mazes (also strengthening and bilateral)– PlayDough activities

Strengthening warm-up Formed letters with “snakes” Wrote letters into patted-down PlayDough (strengthening)

– Ground discrimination worksheet

Week 3 Results

Letter formation on the ground discrimination worksheet was very wobbly indicates we should perhaps work on more strengthening

He often fails to take up the entire area designated for a letter leads me to believe there are still perceptual problems

– Performed very well on visual perceptual activities, which focused on visual fixation/tracking, visual memory, and visual, figure, & ground discrimination

Has much difficulty in completing arm circles and rolling object back and forth needs work with gross motor skills (although he gets this in a special session with Lindsay)

Continued to respond well to bilateral activities

Week 3 Results: Figure Discrimination

Week 3 Results: Visual Discrimination

Week 3 Results:Ground Discrimination

Week 3 Results: Mazes

OVERALL RESULTS:Week 1 vs. Week 3

Observation week vs. Week 3

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