Beyond Paper & Ink: Relating to the Related Service of Occupational Therapy
Shaw, Angela, The Exceptional Parent
Today, thanks to evolving special education legislation (see definition box: IDEIA, page 42), as well as increased knowledge relative to student learning profiles or the unique learning strengths and challenges of a child, there is a broad range of free and appropriate public education (FAPE) programs available to our students with special needs through their Individualized Education Plans (IEP). A broad range of related service providers including physical therapists and occupational therapists, are at hand to offer consultive and therapeutic services for students who demonstrate such need. Parents and educators are encouraged to communicate on a regular basis with related service providers so that accommodations and practices can be maintained throughout the child's day, to the extent possible, within various settings. Through collaborating or working together, knowledge from parents, educators, and specialized service providers is merged. The connectivity between home and school serves to increase understanding of a student's strengths and needs and, thereby, increases intensity, duration, and the likelihood of generalization of skills across the various spheres of life the child encounters.
Although physical therapists (P.T.) are relatively well-known players in the medical and educational realm, occupational therapists (O.T.) are less well known. Often, people confuse occupational therapists with physical therapists. Some assume that occupational therapists assist people in choosing a career or occupation. In fact, O.T.s assist people with the "job of living," according to Pattie Overduin, sole occupational therapist within Snowline Joint Unified School District in Southern California. Overduin's straightforward account of the purpose of an occupational therapist correlates well with that of the Bureau of Labor and Statistics (BLS). According to the BLS, "Occupational therapists use specialized knowledge to help individuals perform daily living skills and achieve maximum independence."
Overduin, graduate of Loma Linda University, is a school-based therapist who made the switch from clinically-based O.T. in the 1990s. She expresses concern relative to the shrinking occurrence of children playing outside and exploring their environments on foot. Such outdoor activities serve to promote development of visual processing through visual scanning of distant objects and development and strengthening of gross motor skills. Overduin shares that O.T.s are active in all areas of life from pediatrics to geriatrics. A perusal of The American Occupational Therapy Association web site (www.aota.org), a national association Established in 1917 to represent interests and concerns of practitioners and students of occupational therapy and to improve the quality of O.T. services, offers articles ranging from Alzheimer's to autism.
Whereas occupational therapists in clinical settings work as part of a health care team with individuals from infancy to elderhood in connection to functionality in relation to living in environment through utilization of their adaptive equipment, such as the absence of or a non-functioning limb, wheelchairs, or other adaptive devices to assist with furthering independency or activity within their home or work environment, the occupational therapist within the educational setting evaluates students with disabilities and assists with modifying classroom equipment and helps students participate in school activities (BLS, 2008-09). Within the school setting, O.T.s are considered a related service, in relation to special education. O.T. services are attached and related to a child's existing IEP. Recommendation for O.T. evaluation is linked to educationally relevant outcomes, progress on goals and the child's functional academic tasks required within the classroom. Upon referral to an occupational therapist, the O.T. will evaluate the child's capabilities, determine therapy needs, modify classroom equipment, or help the child participate in school activities (BLS, 2008-09).
Overduin reports that her service delivery models are carefully
calculated to match the individual needs of the student. Her focus is to promote student access to the general education curriculum, customized to the student's individual needs, to the extent appropriate. She may also be observed leading small groups of students in therapies and/or exercises designed to assist with motor planning, fine motor, or strength-building skills. Furthermore, Overduin collaborates with general and special education teachers and paraprofessionals (sometimes known as special education aides) in order to assist with differentiating (see definition box, Differentiated Instruction, next page) and customizing academic curriculum to create opportunities for students to access general education curriculum based upon their unique learning channels. Differentiation strategies often take into consideration the student's visual discrimination, fine motor, or organization needs. Such strategies may include visual schedules and prompts, specially lined or formatted paper, or specially designed visual structures (See figure A, next page, for an example).
Additionally, Overduin's consultation services extend to observation of students within the classroom setting. Oftentimes, Overduin participates in classroom observation during a time or subject in which a student is exhibiting difficulty, in order to determine what obstacle is causing the student to stumble. She may offer suggestions or accommodations to include visual prompts or alternative ways of presenting the material to the student. Many times, she will offer suggestions relative the manner in which the student interacts with the material based upon their unique learning profile. For example, rather than passively studying the number of sides on geometric shape within a math text book, Overduin may recommend the student trace and cut out triangles and squares of different sizes and then categorize the shapes based upon the number of sides. Such an interaction offers a more active experience with shapes and geometry. Additionally, through such an activity, the student is offered an opportunity to build competence with fine motor skills and employ kinesthetic and visual modalities or strategies.
Her consultation also extends to other related service providers ranging from speech and language pathologists, physical therapists, clinical counselors, and school psychologists. Overduin's insight and knowledge regarding a student's sensory awareness, such as the awareness of having a smile on his/her face can assist with a counselor's work with building friendships. The speech and language pathologist may require this knowledge, in order to assist the student with forming mouth formations to articulate specific sounds such as the sound of /r/. Further awareness of the sensory issues faced by a student will assist with classroom interactions between teacher and student and, therefore, promote systematic support across learning environments. The circle of communication is a critical step toward promotion of the generalization of skills across the environments and lifespan of the student.
A package of comprehensive services include:
* Facilitation of fine motor, visual motor and trunk strength.
* Promotion of listening skills and following directions.
* Facilitation of social interaction and play.
* Promotion of executive functions, organization, and motor planning.
* Regulating sensory processing issues.
The cornerstone of such an occupational therapy program is working toward a seamless system of supports through consultive and therapeutic models, in order to provide services that will move her students toward greater functionality within the school setting and offer a platform to propel them toward generalization of these skills within their home and community lives. Her goal is to work herself out of a job with each and every one of her students. She is excited about her recent project involving the design and development of a motor lab within a classroom at two of her elementary sites. Within the motor lab students will receive supervised access to therapeutic exercises and equipment daily within the permanent structure of the lab equipment. Further, educational providers, including paraprofessionals and special educators, will receive instruction on the use and purpose of the equipment. Through this project, Overduin looks forward to increased intensive services for students. Additionally, the prospect of offering opportunities to build the skills and understanding of the staff who work with the students is a likely outcome of the focused intervention and, thereby, will likely provide systematic delivery throughout a broad spectrum of educational environments.
As an additional benefit, Overduin's intensive on-site motor lab project offers systematic and structured opportunities for students on the autism spectrum to apply play and leisure practice to their school day. The systematic piece is offered through regularly scheduled peer mediated events within the occupational therapy time, which is critical to students' on the spectrum in furthering their ability to generalize their direct social skill training across settings. Through these reverse mainstream opportunities, wherein peers with typically developing social skills are trained to interact and model appropriate play behaviors, students on the spectrum are offered the direct instruction that they require from authentic models in systematic methodologies.
Through special education related services such as Overduin's occupational therapy program, students are provided with meaningful and targeted services customized to their unique needs.
The Individuals with Disabilities Education Improvement Act of 2004 (IDEIA 2004), continues to contain the Early Intervention Program for Infants and Toddlers with Disabilities (birth-2) under Part C of IDEA. Children and youth (ages 3-21) receive special education and related services under IDEA Part B, within the school setting, as determined by IEP team. Fundamental to a meaningful service model that provides educational benefit customized to a student's unique need requires the merging and collaboration of the student's entire IEP team, to include educators, related service providers and family, within the delivery package provided within the instructional day beyond the paper and ink of the legislation guidelines offered within IDEIA 2004.
RELATED ARTICLE: OCCUPATIONAL THERAPY AND IEP
The following activities will assist with increasing strength and control in the small muscles of the hands and fingers. These activities could also be beneficial in improving visual and sensory motor skills.
* Shape play dough with hands, cookie cutters, or rollers
* Build with blocks (start with bigger ones and gradually move to smaller ones, as control is gained).
* Paint, color, and trace (start with thicker brushes, crayons, and pencils and move to thinner tools, as control is gained).
* Put puzzles together.
* Bead bracelets & necklaces.
* Blow bubbles and pop bubbles with one finger.
* Hand and finger puppets
* After placing a plastic letter, number, or other familiar item in a bag, the child determines what it is using her hands through tactile feedback.
* Draw with crayons between toes.
The activities listed below will assist with increasing body awareness, improve posture, assist with executive functioning/ motor planning, and build strength and balance.
* Set up an obstacle course to include:
* Walking heel-to-toe along straight or curved line. Create a customized balancing line by repurposing a garden hose in the back yard or making a design on the living room floor with a few yards of yarn or ribbon.
* Pulling a hula hoop over head and stepping through.
Fig. A: A Trick to Help with ABC Order
Constructing simple visual structures, such as the graphic organizer above, assist students who demonstrate visual processing and planning deficits to build a mental picture or schema and lessens frustrations. For students requiring further scaffolding, he or she may need to be supplied with a pre-numbered sheet of paper in which to write the ordered words upon.
* Drawing a sideways figure 8 on the chalkboard or in air.
* Crawling through a tunnel. Create your own: face two to five sets of chairs back-to - back ten inches apart and clothespin a blanket over them.
* Follow the Leader Games:
* Propose actions to cross the midline or center of the body (i.e.: touch right knee with left hand).
* Include two to three step activities for motor planning (i.e.: visually demonstrate an activity and say, "Listen, touch your nose, pull your right earlobe with your left hand, and hop on one foot. Go."
* Increase and strengthen visual discrimination and planning through non-traditional flashcard activities:
* Lay flash cards on the floor; verbally or visually propose a scavenger hunt for specific numbers, letters, words, colors, or icons.
* Hold up an equation (2x4= __ or 2 __ 4=8); have student find the completing flashcard (8 or +).
* Hold up a word such as bake or pail; have student hunt for vowel, phonics rule, or rhyming word (V/C/V or VV).
* Hold up a sentence strip (The girl is tall?); have student hunt for punctuation that corrects the sentence (.).
* Dance, stretch, or include yoga to music.
* Beanbag activities: toss a beanbag into a basket, to one another, to the beat of the music from hand-to-hand, or march with it balanced on the head.
Differentiated Instruction: A strategy promoting teacher response to varied learner needs within the classroom; offering engagement and challenge to students with vastly different strengths, interests, and learning styles, in order to create the best learning experience for all (Tomlinson, 2000 and Shaw, 2010)
Individuals with Disabilities Education Improvement Act (IDEIA): Originally passed by Congress in 1975 under the title Education of All Handicapped Children Act, the most current reauthorization of the original act is now codified as IDEIA and is often referred to as IDEA 2004. It is a federal statute related to providing a free, appropriate public education (FAPE) and early intervention services to students with disabilities from birth through 21 years old within the least restrictive environment (LRE) (U.S. Dept. of Education).
The American Occupational Therapy Association (AOTA) web site. Home page. Retrieved January 29, 2012 from www.aota.org.
Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2008-09 Edition, Occupational Therapists, Retrieved July 4, 2009 from http://www.bls.gov/oco/ocos078.htm
Shaw, A. (2010, Sept.). Bridging curriculum access through differentiation, part 1: Historical and background perspectives. Exceptional Parent Magazine. 40(9), 32-33.
Tomlinson, C.A. (2000). Differentiation of instruction in the elementary grades. Champaign, IL: ERIC Clearinghouse on Elementary and Early Childhood Education. (ERIC Digest EDO-PS-00-7). Retrieved July 11, 2012, from http://www.ericdigest.org/2001-2/elementary.html
U.S. Department of Education, Office of Special Education and Rehabilitative Services. Retrieved July 11, 2012 from http://www.2.ed.gov/about/offices/list/osers/nidrr/faq.html
By Angela Shaw, SAI and Pattie Overduin, O.T.
About the Authors:
Angela Shaw, Specialized Academic Instructor, and Pattie Overuin, Occupational Therapist, collaborate across the Snowline School District in California to guide paraprofessionals toward working effectively with students with autism. Shaw has authored several articles relative to students with special needs and holds Master's degrees from Azusa Pacific University in Special Ed. and School Counseling. Overduin is a parent trainer in Positive Parenting and earned her degree in Occupational Therapy from Loma Linda University.…