Occupational Therapy

What is occupational therapy in the school setting?

Occupational therapy is a "…supportive service required to assist a child with a disability to benefit from special education..." Students who receive occupational therapy services in the school setting have been determined to need occupational therapy in order to benefit educationally. One of a child’s roles is to be successful both academically and socially in school. Some children require a modified curriculum and/or additional assistance to achieve mastery in these areas. Through the use of adaptation, teaching, therapeutic exercise and play, an occupational therapist may support a child in reaching their curriculum goals.


What is a related service?

Related services are support services for special education and are not instructional services.

There are many “related services” that might benefit a child with a disability, just as there are many services that might benefit a child who does not have a disability. However, the law does not require that such services be provided. Rather, the legal duty to provide a related service arises only when without the service the child’s educational program would become less than appropriate, i.e., when the child would not benefit from his educational program without these services. In determining whether a related service is “necessary” for a student, the district should rely on a related services assessment. (Susan B. Graham, 1996)


What areas do occupational therapists address with their students in the school setting?


Fine motor skills: hand development, hand strength, grasp patterns, pencil grasp, handwriting, dexterity, scissor skills, shoulder/trunk strength and stability.
Self-help skills: manage clothing in the school setting (i.e., buttons, zippers, snaps, tie shoes), feeding skills, and use of adaptive equipment.

Assistive Technology: provision of any “item, piece of equipment, or product system whether acquired commercially or off the shelf, modified, or customized, that is used to increase, maintain, or improve the functional capacities of a child with a disability”.


How does a child qualify for occupational therapy services?

First, it must be determined that the child is eligible to receive special education services. Then, an Individual Education Plan (IEP) must be developed to address the academic areas of concern for the child. If the child is not making progress toward mastery of the IEP goals, additional related service support such as occupational therapy may be recommended. A referral is made to evaluate the child in the school setting to determine eligibility for services. An IEP meeting will be held to discuss the results of the occupational therapy evaluation. If a child does not qualify, recommendations may be made for additional assistance.


If a child is receiving private or clinical occupational therapy, will he/she automatically receive occupational therapy in the school setting?

Not necessarily. The goal of medical/clinical therapy is to treat the symptoms of the underlying cause of a child’s disability. The goal of educational therapy is to assist the student in attaining educational goals. For example, in clinical therapy a child’s goals may include increasing range of motion and decreasing muscle tone to improve quality of movement. In the educational environment this child’s disability might not interfere with his/her ability to perform in the classroom, thus, he/she would not be eligible for services in the school setting.


A student in my class is dysgraphic. What do I do?

First, go online and read about the characteristics of dysgraphia. Before concluding a child is dysgraphic, ensure that the student has the appropriate sub-skills (prewriting skills, formal handwriting instruction, visual motor skills, etc.). Often, children just need more exposure, practice and repetition with handwriting. Dysgraphia, however, is a neurological disorder characterized by writing disabilities. Specifically, the disorder causes a person's writing to be distorted or incorrect. In children, the disorder generally emerges when they are first introduced to writing. They make inappropriately sized and spaced letters, or write wrong or misspelled words, despite thorough instruction. Children with the disorder may have other learning disabilities, however, they usually have no social or other academic problems. In addition to poor handwriting, dysgraphia is frequently characterized by wrong or odd spelling, and incorrect production of words (i.e., using "boy" for "child"). The cause of the disorder is unknown.

Occupational Therapy Teacher Tips

Dysgraphia

- Build handwriting instruction into the student's schedule. The details and degree of independence will depend on the student's age and attitude, but many students would like to have better handwriting if they could.
- If the writing problem is severe enough, the student may benefit from a laptop keyboard or portable word processor.
- Keep in mind that handwriting habits are entrenched early. Before engaging in a battle over a student's grip or whether they should be writing in cursive or print, consider whether enforcing a change in habits will eventually make the writing task a lot easier for the student, or whether this is a chance for the student to make his or her own choices.
- Teach alternative handwriting methods such as "First Strokes" and kinesthetic handwriting learning techniques.
- Even if the student employs accommodations for writing, and uses a word processor for most work, it is still important to develop and maintain legible writing. Consider balancing accommodations and modifications in content area work with continued work on handwriting or other written language skills. For example, a student for whom you are not going to grade spelling or neatness on certain assignments may be required to add a page of spelling or handwriting practice to his portfolio.

Kinesthetic Learning

The following are various methods used to facilitate learning of proper letter, number and shape formation:

- Air writing (visual/kinesthesia) - draw shapes or write letters with large arm movements with and without vision.
- Mystery writing (visual/kinesthesia) - the teacher or peer moves the student’s hand to form shapes or letters on blackboard or in the air and student guesses what was drawn.
- Rainbow writing (motor memory/visual) - trace over shapes/letters or numbers several times with different colors (crayons/markers on paper or chalk on board)
- Tactile writing (proprioceptive/tactile/kinesthesia) - trace shapes, letters, or numbers on carpet square, sandpaper, shaving cream, window screens, foil, finger paints, sand, pudding, Cool Whip, etc.
- Vibrating pen (proprioceptive/kinesthesia) - practice shapes or letters while getting good sensory feedback.
- Constructional writing (proprioceptive/kinesthesia/tactile) - construct basic lines/shapes on a color board or flannel board using Wikki Stix, play dough, pre-cut flannel pieces, etc.

Quick Fixes

- Have student hold a novelty eraser tucked under the ring and little fingers while writing, cutting, drawing or using manipulatives. This promotes the use of the thumb, middle and index finger for skilled movement and the ring and little fingers to support the hand.
- Sharpen or break pencils down to about 2 inches in length to encourage efficient pencil grasp and better control of the pencil.
- Place Cylindrical Foam sleeves that are approximately an inch long on writing utensils to increase the diameter and promote proper finger placement.
- Use a masking tape outline on the desktop to indicate how paper should be slanted.
- If the student writes with too much pressure on the pencil, have him/her write with a 0.5 lead mechanical pencil and/or have him/her write with their paper on a carpet square or placemat. These techniques will teach a student how to vary the pressure used on the pencil to avoid breaking the lead or putting holes in the paper.
- If a student writes with a “hooked wrist”, have them do written work on a vertical surface just above eye level.

Posture and Stability

- Look at correct sitting posture and appropriate chair and table heights. A child’s feet should be flat on the floor and the desktop should be 2 inches above the bent elbow.
- Use the 90 - 90 - 90 rule. Ankles, hips, and knees should be bent to a 90-degree angle for appropriate sitting posture.
- If table is too high, elbows will be up and out to sides. If table is too low, the child will slump in their chair or rest their head on their hand.
- Use footstool to support feet if the child’s feet do not rest flat on the floor. Allow students to work in various positions other than seated (standing at a vertical surface, lying on the floor propped on elbows). Do warm-up activities to provide kinesthetic input to large and small muscles groups (Jumping jacks, Dancing Finger songs, Donkey Kicks or Animal Walks).

Vertical Surfaces

Working on a vertical surface promotes the wrist extension and shoulder stability necessary for control of the fine movements involved in writing.

When working on a vertical surface, paper or work should be positioned just above eye level.

Examples of ways to incorporate vertical surfaces into your classroom:
- Let the children write/draw on easels, white boards and/or chalkboards.
- Desktop slant boards can be used for individual work at the desk.
- You can also place a 4-5 inch empty 3-ring binder on the desk for incline. Position the binder with the rings toward the top of the desk and the slant toward the child. Then rotate the binder to a 45-degree angle. Consult with your occupational therapist on any questions you may have.
- Have your students draw or write on paper taped to the wall.

Pencil Grasp

In an efficient grasp, the pencil is held between the pads of the thumb and index finger while resting on the middle finger. An acceptable variation of this is when the pencil is held between the pads of the thumb and index/middle fingers while resting on the ring finger. The pencil can also be held between the index and middle fingers, in opposition with the thumb.

If a child is using an efficient grasp, their thumb and index finger should form a circular shape.

An inefficient grasp can include any of the following: fisted grasp, pencil held between the pads of the thumb and all four fingers, thumb wrapped over the top of the index and middle fingers, thumb tucked under the index finger, the hand held in a thumb down position, index and middle fingers wrapped around the pencil, or thumb pressing the pencil into the side of the index finger (thumb and index do not form a circular shape).

View videos on YouTube "Holding a Pencil."