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ABCs of occupational therapy

Published by , on Apr 11, 2016

The therapy world can often be full of unfamiliar vocabulary, especially when it comes to child development. In honor of April, Occupational Therapy Month,  members of our occupational therapy team put together a list of terms that can help clarify some of the many components that contribute to a child’s development, as they learn and experience the world around them, and provide parents of children who are undergoing a therapy program with the tools to communicate confidently with their child’s care team. 

Adaptive response – An action that responds to information from the environment in an appropriate and successful manner. Adaptive responses are the goal of sensory integration, and allow the child to learn and interact safely and appropriately. For example, an adaptive response to hearing a phone ring would be to answer the phone, not to jump up and cover the ears.

Assistive technology – High-tech or low-tech devices that help an individual achieve the greatest independence and access to their environment. This could include adaptive equipment such as aids for dressing and feeding, orthotics, communication devices, adapted computers or mobile technology, mobility equipment or environmental controls.Virgina AT brochure

Auditory discrimination – The ability to hear and distinguish between sounds in the environment. A child who has challenges with auditory discrimination may have difficulty filtering out unnecessary noise to focus on relevant sounds such as conversation or instructions from a teacher.

Bilateral coordination – The ability to use both sides of the body together in a smooth, coordinated manner to accomplish a task. This may involve symmetrical movements, such as jumping jacks or catching a ball, or asymmetrical movements such as climbing a ladder or stringing beads.

Body awareness – The perception of the body and its parts, including where they are in space, how they move and what touch sensations they are feeling. Good body awareness is important for motor skill development.

Cognitive skills – These include skills necessary for learning, such as memory, attention, sequencing and planning that are essential for completing functional tasks. Therapy can address ways to build and practice these skills, as well as ways to compensate when these skills are impaired.

Eyehand coordination – Skilled use of the hands and eyes for completing an action. Eye-hand coordination is often considered in sports like softball, but it is important for completion of everyday tasks as well, like scooping food and bringing it to your mouth during meals.

Fine motor skills – The skilled use of one’s hands. Fine motor skills can be broken down to include the ability hold and move object in one hand without assistance from
the other hand (in-hand manipulation), the ability to use both sides of the hand separately (dissociation), and precise grasp patterns. These skills translate into functional tasks, such as snipping with scissors, picking up Goldfish crackers, and putting coins in a piggy bank.

Functional ability  Occupational therapists look at the skills that make up functional tasks and help children develop the skills necessary to complete tasks in their everyday lives. It is not solely, “Can a child achieve a precise pincer grasp?”, but “Does this skill translate to the child’s ability to do a functional task, such as button their pants?”

Functional tasks – Occupational therapists consider functional tasks to be those that are appropriate and purposeful, and differ based on a child’s chronological or developmental age. For example, being able to sort and fold laundry is an anticipated functional task for a teenager as it requires a higher level of skills to perform, where while being able to put shapes into a shape sorter is a functional task for a toddler.

Grasp pattern – The way in which a child grasps an object or utensil. As a child develops and matures, their grasp patterns become more refined to allow for more precise and skilled manipulation of objects. For example a 6-month-old may use a “raking” grasp between their fingers and palm, whereas a 12-month-old would use a “pincer” grasp between the tips of index finger and thumb to grasp the same object. Grasp patterns on writing utensils are very important to allow precise control for writing as well as preventing hand fatigue.

Gross motor skills – Coordination and strengthening of large muscle groups throughout the body. Occupational therapists are often working to coordinate both sides of the body through activities such as catching a ball, getting dressed or crossing the monkey bars. The ability of a child to use their arms and legs in a coordinated way impacts the way they move through the environment.

Hand preference – Children typically begin to develop a preference of right or left hand for skilled tasks between the ages of 2-4, and by kindergarten most children should establish firm hand dominance. Having a dominant hand is important for fine motor skill development so that the dominant hand can have the many repetitions required to become as coordinated and strong as possible, while the opposite hand learns to be the “helper” hand for two-handed activities.

Interactive Metronome assessment and training – Use of a metronome beat to provide opportunities for coordination, timing, rhythm, sequencing and motor planning. The software of the Interactive Metronome program records the user’s movements in relation to the metronome beat, so that therapists can track improvement in coordination and rhythmicity over time.

Midline (or “crossing the midline”) – Midline is the imaginary line that runs down your body, dividing it into right and left sides. The ability to reach across midline indicates that the right and left sides of the brain are communicating, allowing for more coordinated movements. Being able to cross midline with your dominant hand is important to ensure your dominant hand is getting lots of skilled practice. Consider if you only used your right hand on the right side of your body and only used your left hand on the left side of your body. Not only would it feel funny, it would be difficult to dance, play sports or get dressed.

Muscle tone – The amount of tension in a muscle at rest. Children with hypotonia, or low muscle tone, have reduced tension and therefore require even more force to recruit muscles to move. Children with hypertonia, or high muscle tone, have increased tension and may have difficulty with flexibility or shifting smoothly between activation of different muscle groups.

Occupational therapist – A professional who works with varying ages (from infants to adults) and diagnoses to promote participation in and completion of functional tasks. Occupational therapists perform evaluations to assess a patient’s skills and potential deficits in order to develop and implement a treatment plan for intervention. Today’s entry level occupational therapists obtain a master’s degree and participate in numerous “fieldwork” or practical experiences in preparation for a national board exam. In working with children, occupational therapists are known for helping children develop skills, adapt to injury, and process sensory input to better participate in play, school and self-care.

Orthotics – Devices such as splints or braces that provide support, improve function, or prevent injury or contracture in a specific part of the body. These vary widely from shoe inserts or ankle supports to improve gait, to trunk and lower back supports. Occupational therapists specialize in orthotics that improve function of the upper body, (for example, splints that provide stretch to wrist or elbow to prevent joint stiffness after a stroke or brain injury, or hand splints that help a child better grasp eating utensils). A therapist may make a custom splint for a client, help to order and fit a commercially available splint, or coordinate with a specialized professional (orthotist) to best meet their orthotics needs.

Proprioception – The sensory information that travels to the brain from the muscles, tendons, ligaments and joints. Proprioception gives the brain feedback about position in space and movement of the body. For example even with your eyes closed, you could feel whether or not your arm was raised or lowered.

Self-help skills – The ability to have age-appropriate independence in caring for oneself, including dressing, grooming, bathing, feeding, toileting and sleep.

Sensory defensiveness – A sensitivity to sensory input that results in an “overreaction” from the body. If an experience with a form of sensory input was negative or overstimulating to a child, such as the feeling from walking on rough sand at the beach, the child will avoid or be defensive to similar situations. Such defensiveness can make it challenging to manage new environments or experiences for children and their family.

Sensory diet – Similar to the nutritional needs of the body, a sensory diet is made up of the varied sensory experiences a child takes in each day to meet their sensory needs for learning, play, and social interaction. While most children seek out a variety of appropriate sensory experiences independently through play, sometimes they benefit from having a planned and scheduled “diet” that structures the sensory activities to improve regulation and successful interaction with the world around them.

Sensory integration – The body’s ability to take in sensory input, make sense of it, and use it functionally. Some sensory input can be easier to “integrate” than others, depending on the child’s nervous system. For example, some children are excellent at integrating visual input, making it easy for them to catch a ball tossed from a friend. Other children may struggle to process visual input, instead getting caught up in all the visual details of the environment (like the trees and bright sunlight) and missing the motor response of catching the incoming ball.

Sensory play – Play that exposes children to a variety of sensory experiences for multiple systems, including touch, sight, sound, smell and movement. Sensory play is essential for children to learn how to process information from their environment and to develop refined motor skills.messy paint-iStock_000029832300Small

Sensory processing – The body’s ability to take in sensory input from the environment and understand the message. Consider hearing the sound of a lawn mower running outside. Someone with typical sensory processing hears the hum, recognizes the source of the noise, and is not afraid. A child who struggles to process this auditory input may respond in fear or anxiety instead of understanding.

Sensory processing disorder (also called “sensory integration dysfunction”) – When one’s body does not receive or understand sensory messages from the environment as they were intended. A child may be “over-sensitive” to sensory input (hypersensitive) or “under-sensitive” (hyposensitive). For example, a child who demonstrates a high sensitivity to sensory input may find the touch from a classmate brushing against their arm uncomfortable or painful. On the other end, a child who is under responsive to the same input may not even notice that they havebumped into anyone and ends up leaning on their classmate. Although the processing of the same input is different, each child responds in a way that could have negative consequences for function and social interaction. The child who perceived the touch as painful may push the classmate away, starting an argument. The child who barely perceived the touch at all may scare away potential friends because of what looks like lack of understanding personal space.

Sensory regulation (see sensory integration definition)

Social skills – Skills necessary for appropriate interactions with one’s peers and environment. Depending on the age of the child, social skills can include understanding turn taking, non-verbal cues in conversation, and what questions are appropriate to ask people to learn more about them. Modeling is an important tool in teaching social skills, and practicing in age appropriate situations like school and sports teams helps children integrate these skills in real life.

Tactile defensiveness -A sensitivity to touch sensations that results in a negative response to light touch or an avoidance of touch inputs. Examples may be avoiding messy play, disliking clothing tags or grooming, or over-reacting when being tapped or bumped unexpectedly by another person.

Vestibular system  The sensory systems responsible for detecting movement of the head in relation to gravity. The organs of the vestibular system are very tiny and located in the inner ear. These structures, called the otolith organs and the semicircular canals, have receptors imbedded in membranes that are highly sensitive to the movement of fluid that shifts as a person moves. This includes rotation around an axis (rotary movement) and movement in a back-and-forth, up-and-down or side-to-side direction (linear movement). The vestibular system provides essential sensory information to the brain. For example, even with your eyes closed and your body perfectly still, you could still feel the rocking of a boat. 

Visual motor integration – The process of taking in visual information, processing it in the brain, and coordinating a physical movement in relation to what you see. This requires both visual perception and motor coordination.

Visual motor skills – Tasks that require visual motor integration. These include eye-hand coordination activities such as reaching, pointing, grasping, throwing and catching, as well as precision skills such as writing, drawing, copying, tracing and cutting.

Visual perceptual skills – The ability to understand what the eyes are seeing. Activities such as puzzles, mazes and connect-the-dots are not only about how the hands are working, but how the eyes are perceiving what they see in order to perform the necessary actions.

Information provided by Sarah Phillips, occupational therapist, Fredericksburg Therapy Center, and Mary Williamson, occupational therapist, Bon Air Therapy Center.

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