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 with good verbal communication although he often struggles to co-ordinate his breathing and speaking.
Reason For Referral
Paul was referred for occupational therapy due to difficulty with daily tasks such as washing, dressing, school work and playing with his peers. He also demonstrated difficult behaviour, shouting and swearing at his parents usually in frustration when asked to do something he had difficulty with.
Occupational Therapy Assessment
Paul underwent an initial assessment using a combination of formal and informal assessment tools. Formal tools included a Sensory Integration and Praxis assessment (SIPT) and an assessment of motor and processing skills (AMPS). 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.
The 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 causing him to become extremely frustrated and low in mood and subsequent withdraw from activities at home and at school.
Occupational Therapy Intervention
Paul was offered a 12 week programme of intense occupational therapy, the purpose of which was to assess the causes of his 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 difficult behaviour towards his family.
The Occupational Therapist worked closely with Paul’s family and school and the following strategies were implemented:-
- A sensory motor program at school involving daily desk-based tasks which his teacher supported him in as well as intensive weekly sessions with therapy staff in a sensory integration suite;
- Enrolment in an occupational therapy daily living skills group to assist him in developing his ability to sequence actions and steps of tasks;
- The provision of visual aids at home to support his understanding of the order of tasks;
- Support for his family on how to help him through tasks including strategies such as completing warm up tasks before engaging in motor activities and providing 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;
- Close liaison with the Physical Education (PE) team at school as this was a huge cause of anxiety for Paul who struggled to play in a team and complete the active tasks asked of him;
- A program of individual motor tasks to complete during PE such as moving from one space to another through a simple obstacle course in order to improve 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, all of which helped him increase his confidence, feel part of the team and begin to build friendships with his peers.
Initially Paul was unable to carry out gross motor tasks such as jumping, rolling and running and fine motor tasks such as doing up buttons and handwriting as a result of which, he also struggled significantly with functional tasks such as washing and dressing. His main goal of therapy was to be able to kick a ball with his friends.
Following occupational therapy intervention, 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. He is also able to kick a ball and often has fun with his friends during lunch breaks at school. His confidence and mood have improved and he is more willing to try new things and attempt new tasks.