Paul is a 12 year old boy who lives with his parents and attends a special needs school. He has a moderate learning disability and severe dyspraxia. Paul has good verbal communication although he often struggles to co-ordinate his breathing and speaking.
Reason For Referral
Paul was referred for occupational therapy because he was struggling with daily tasks such as washing, dressing, school work and playing with his peers. He also demonstrated difficult behaviour in that he would shout and swear at his parents. This behaviour was often a result of frustration if Paul was asked to do something that he struggled with.
Occupational Therapy Assessment
Paul underwent an initial period of assessment. This involved a combination of formal and informal assessment tools. Formal tools included sensory integration assessment, assessment of motor and processing skills (AMPS) and an assessment of his ability to carry out fine motor skills such as hand writing. These assessments were augmented with informal observations of Paul at home and at school as well as interviews with his family, teachers and respite carers.
This assessment identified that Paul’s difficulties are a result of a combination of issues including:-
- Poor proprioception (a difficulty with knowing where his body is in space);
- Poor tactile discrimination (a difficulty with accurately perceiving touch);
- Poor motor planning and control;
- Difficulty with understanding the order and sequence of tasks.
These difficulties led to Paul often failing at tasks given to him leading him to become extremely frustrated and low in mood subsequently withdrawing from activities at home and at school.
Occupational Therapy Treatment Plan
Paul was offered a 12 week period of intense occupational therapy. The goal was to assess the causes of Paul’s difficulties, provide support for him to work on and improve his skills, adapt the environment and approach in order to make tasks easier for him and reduce the behaviour he was expressing towards his family.
The occupational therapist worked closely with Paul’s family and his school and the following strategies were implemented:-
- A sensory motor program was put in place for Paul to complete at school - this involved daily desk based tasks which his teacher supported him in as well as weekly intense sessions with therapy staff in a sensory integration suit;
- Paul was enrolled in an occupational therapy daily living skills group to assist him in developing his ability to sequence actions and steps of tasks;
- Paul was provided with visual aids at home to support his understanding of the order of tasks;
- Paul’s family were given support on how to help him through tasks including strategies such as completing warm up tasks before engaging in motor activities and providing Paul with touch support rather than demonstration. Paul found copying movement very difficult and needed support to place his limbs in the right place before beginning tasks;
- The occupational therapist also worked closely with Paul’s physical education (PE) team at school. PE was a huge cause of anxiety for Paul who struggled to play in a team and complete the active tasks that were being asked of him;
- Paul was given a program of individual motor tasks to complete during PE such as moving from one space to another through a simple obstacle course. This improved his ability to plan his movements and carry out a sequence of steps. He was also supported to help his team mates by keeping score and supporting the teacher in setting out equipment etc. This helped Paul increase his confidence, feel part of the team and begin to build friendships with his peers.
Paul began the process not being able to carry out gross motor tasks such as jumping, rolling and running or fine motor tasks such as doing up buttons and handwriting. As a result, he also struggled significantly with functional tasks such as washing and dressing. Paul’s main goal of therapy was to be able to kick a ball with his friends.
Following occupational therapy input, Paul is now able to clean his own teeth, dress with minimal support and engage in class work at school. He is given a great deal of praise for completing his tasks and his family and school staff see very little poor behaviour as a result of frustration. Paul is also able to kick a ball and often has fun with his friends during lunch times at school. His confidence and mood have improved and he is more willing to try new things and attempt new tasks.