Occupational Therapy Module

Table of Contents
Introduction ...................................................... 1
• What is Occupational Therapy?
• Education and Training
• Work Settings

History ............................................................... 2
Occupational Therapy Framework ..................... 3
OT Practice in Pediatrics .................................... 4
• What do pediatric occupational therapists do?
• Areas of Assessment and Intervention
• Practice Settings
• Assessment Tools
• Intervention Strategies and Outcomes
Interdisciplinary Collaboration ........................... 7
When to Refer to OT........................................... 7
Case Studies ...................................................... 8
Resources ........................................................ 10
Credits and Acknowledgements ....................... 11
Return to LEND Modules webpage .................. 12

Last reviewed 8-30-17

 UW LEND – Occupational Therapy Module

Introduction
What is Occupational Therapy?

Occupational therapists promote the health and participation of

people, organizations, and populations through engagement in
occupation. The term occupation refers to daily activities that
occupy a person’s time. This includes things such as: activities
of daily living, rest and sleep, education, work, play, leisure, and
social participation.
American Occupational Therapy Association Video
How OT Changes Lives – What OT Can Do For You

Education and Training

Occupational therapists must earn a degree from an accredited occupational therapy graduate program.
Training includes didactic coursework and fieldwork training in a variety of settings. The entry-level degree
for an occupational therapist is a Master’s degree (MA, MS, or MOT) or a doctorate in occupational therapy
(OTD).

To be eligible for state licensure, one must obtain an entry-level degree and pass the national board exam
for certification in occupational therapy.

Occupational therapists must complete 30 hours of continuing competency hours every two years to
maintain their occupational therapy license in Washington State.

Work Settings
Occupational therapists work in a variety of settings, including:
- Hospitals
- Schools
- Outpatient clinics
- Early Intervention Programs
- Inpatient Rehabilitation Facilities
- Home-Based Therapy
- Sub-Acute, Skilled Nursing, and Extended Care Facilities
• Hospice Centers
• Industrial, Office, or other Workplace Environments
• Universities and other Research Centers

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 UW LEND – Occupational Therapy Module

History of Occupational Therapy

1900’s: First meeting of the National Society for the Promotion of Occupational
Therapy (later renamed the American Occupational Therapy Association). First OT
practitioners, referred to as reconstruction aides, worked during World War I to
rehabilitate disabled soldiers and civilian patients with a focus on helping individuals
recapture purpose in their lives.
1923: Education standards for occupational therapists established. Expand practice
into mental health.

1930s: Occupational therapy became more closely aligned and identified with
organized medicine, which led to the beginning of a more scientific approach.

1940s: Demand for occupational therapist increased during WW2. Occupational

therapists expanded their role to support activities of daily living.

1950s: Demand for occupational therapists remains high due to medical advances
that extend the lives of individuals with spinal cord injuries, traumatic brain injuries,
and amputations.
1960s & 1970s: Occupational therapy services expand into specialized areas of
pediatrics and developmental disabilities

1965: Medicare begins covering inpatient occupational therapy services.

1975: The Education of All Handicapped Children Act of 1975 passed and
occupational therapists begin working with students with disabilities in schools.
1980s & 1990s: Occupational therapist focus on prevention, quality of life, and
maintaining individual’s independence.

2004: Reauthorization of the Individuals with Disabilities Act (IDEA) extends the
availability of occupational therapy services to all students to promote participation
in school, not just those with disabilities.
Today: Occupation is again the main focus of the profession. Occupational
therapists work in a wide range of settings with individuals with a variety of
conditions, including: prematurity, spina bifida, attention deficit disorder,
developmental disabilities, cerebral palsy, sensory processing differences, autism,
ADHD, Down syndrome, amputation, stroke, arthritis, burns, head injury, dementia,
diabetes, or cardiac conditions.

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 UW LEND – Occupational Therapy Module

Occupational Therapy A person engages in purposeful activities

Practice Framework: out of personal choice and they are
The goal of occupational therapy is to help clients valued, these clusters of purposeful
achieve health, well-being, and participation in life activities form occupation
through engagement in meaningful occupation.
Hinojosa, Kramer, Royeen & Lubeen 2003
These occupations include:

• Activities of Daily Living (ADLs): bathing, dressing, eating, and functional mobility
• Instrumental Activities of Daily Living (IADLs): child rearing, community mobility, financial management,
meal preparation, and shopping
• Rest and Sleep
• Education and Work
• Play and Leisure
• Social Participation

To assure individuals achieve their occupational goals, occupational therapists carefully consider many
factors:
• Client Factors: specific capacities,
characteristics, beliefs that reside
in an individual or group
- Values, Beliefs, and Spirituality
- Body Functions and Structures
• Performance Skills: goal directed
actions that are observable
- Motor and Process Skills
- Social Interaction Skills
• Performance Patterns: used to
engage in occupations that
support or limit occupational
performance
- Habits
- Routines
- Rituals
- Roles
• Context and Environment: the
larger context in which
occupational performance occurs
- Cultural, Personal, Temporal,
Occupational Therapy Practice Framework
Virtual contexts
- Physical and Social (used with permission from by the American Occupational Therapy Association
Environments Copyright © 2014)

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 UW LEND – Occupational Therapy Module

OT Practice in Pediatrics
What do pediatric occupational therapists do?
Pediatric occupational therapists work with children of all ages to help assure the child’s success
performing their occupations in a variety of settings.

Areas of Assessment and Intervention

Pediatric occupational therapists evaluate and provide intervention in the following areas:
• Motor Skill Performance • Social Participation and Behavior
• Sensory Processing • Feeding
• Functional Mobility • Play
• Activities of Daily Living/Adaptive Skills • Assistive Technology
• Visual Perception/Visual Motor Skills • Splints/Positioning Devices

Practice Settings
Pediatric occupational therapists may practice in:
• Hospitals • Public Schools- school-based therapy for students
• Neonatal Intensive Care Unit (NICU) age 3-21 years
• Inpatient and Outpatient Rehabilitation • Private Clinics
• Diagnostic and Follow-Up Clinics • Community Mental Health Programs
• Early Intervention Programs (B-3 services) • Home-Based
- Services provided at an early intervention
center or in the family’s home

Assessment Tools
Pediatric occupational therapists evaluate children through observation, direct testing, and information
gathered from parents and teachers. Assessment strategies depend on the age of the child, presenting
concerns, and the practice setting. Occupational therapists use standardized assessment and structured
clinical observations to assess performance.

Observation and Non-Standardized Assessments

• Classroom observation in the school setting to assess educationally relevant adaptive, motor, sensory
processing, and social interaction skills.
• Play observation in a clinic or home to assess social interaction, play, and motor skills.
• Mealtime observation in a child’s home to assess feeding skills and family dynamics during meals.
• Neuromusculoskeletal evaluation in a hospital or clinic setting to assess muscle tone, joint range of motion,
automatic balance responses, posture, gait and physical strength.
• Parent and teacher informed interview conducted informally, using therapist-designed framework, or a
standardized questionnaire.

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 UW LEND – Occupational Therapy Module

Standardized Assessments

This is a sampling of some of standardized assessments pediatric occupational

therapists may use.

Bayley Scales of Infant and A norm-referenced, standardized tool designed to identify children with
Toddler Development, 3rd developmental delays and to provide information for intervention planning for
children 1-42 months of age. Includes Cognitive, Language, Motor, Social-
edition (BSID-III)
Emotional, and Adaptive Behavior Scales.
Beery- Buktenica Assesses for visual-motor deficits that can lead to learning, neuropsychological,
Developmental Test of and behavior problems. Can be used with individuals age 2-99. Also includes
supplemental Visual Perception and Motor Coordination tests.
Visual Motor Integration
(VMI)
Bruininks-Oseretsky Test of A standardized test that assesses fine and gross motor skills in children age 4-21
Motor Proficiency, 2nd years. Consists of subtests in the following areas: Fine Motor Precision; Fine
Motor Integration; Manual Dexterity; Bilateral Coordination; Balance; Running
edition (BOT-2)
Speed and Agility; Upper-Limb Coordination; and Strength.
Goal Oriented Assessment of An evaluation of functional motor skills within the context of activities of daily
Life Skills (GOAL) living designed for children age 7-17. Consists of seven activities based on real
childhood occupations.
Movement Assessment of Systematic evaluation of motor function in infants from birth to one year.
Infants (MAI) Specifically evaluates muscle tone, reflexes, automatic reactions, and volitional
movement. Produces risk scores for 4, 6, and 8 month old infants.
Miller Function and Assessment of a child’s functional performance related to school participation.
Participation Scales (M-FUN) Specifically tests fine, gross, and visual motor skills. Designed for children age 2-
7 years old.
Peabody Developmental A standardized assessment of fine and gross motor abilities in children age birth
Motor Scales – 2nd edition to 6 years of age. Subtests include: Reflexes; Stationary; Locomotion; Object
Manipulation; Grasping; and Visual-Motor Integration.
(PDMS-2)
Pediatric Evaluation of Evaluates a child’s functional skill ability and degree of caregiver assistance
Disability Inventory (PEDI) needed for self-care, mobility, and social function. Designed for children 6
months to 7 years.
School Function Assessment Evaluates a student’s performance of functional tasks and activities in the
(SFA) elementary school environment. Specifically assesses student participation,
task supports needed, and activity performance. Criterion cut-off scores may be
used to establish eligibility for special education services.
Sensory Processing Measure Provides a comprehensive view of a child’s sensory processing difficulties.
(SPM) and Three questionnaire forms available Home, Main Classroom, and School
Environments for completion by parent, guardian, and/or teacher; age 2-12
Sensory Processing Measure years.
Preschool (SPM-P)
Sensory Profile 2 (SP-2) Used to assess sensory processing patterns in children from birth through age
14 in the context of home, school, and community activities. Separate rating
forms for home and school environments, completed by parent, guardian,
and/or teacher. Provides cut scores and optional percentiles to describe
sensory processing.

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 UW LEND – Occupational Therapy Module

Intervention Strategies and Outcomes

Occupational therapists provide services using one or more of the following models:
- Direct service to the child and family
- Consultation with the family, educational team, and/or other service providers
- Monitoring of performance and progress

In each of these intervention models occupational therapists consider the following outcomes:

Establish a skill or ability that has not been developed

Establish/ yet or restore a skill or ability that has been lost or
Restore impaired.

Example: Working with a child to develop skills in the areas of self-feeding, handwriting, or play. The
OT may fabricate specialize equipment for the child to aid in these tasks.
Support maintaining the skills that a child has achieved, or regained, so that there
Maintain is not a decrease in occupational performance.
Example: In a school environment, the occupational therapist develops a daily motor program for a
student to carry out under classroom staff supervision. The occupational therapist monitors and modifies
the program as needed to optimize the student’s occupational performance in the school environment.

Modification or change to the

environment or the task demands to
Modify enable a child to more independently
engage in a desired occupation.

Examples: Create a quiet, clutter free study space for a student with ADHD to do their homework. Provide a
child with autism a visual schedule with pictures illustrating each step of their morning routine.

Prevent the occurrence of occupational performance problems for children with

Prevent and without disabilities.
Example: Develop a program to increase physical activity participation to prevent obesity.

Create or Provide experiences and environments that support occupational performance.

Promote
Examples: An occupational therapist working in an early intervention program
collaborates a family to create a developmentally stimulating play area in the home. The

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 UW LEND – Occupational Therapy Module

occupational therapist works with the family to create a predictable, consistent bedtime
routine.

Interdisciplinary Collaboration

Occupational therapists interact and practice in collaboration families and with a variety of professionals.
Occupational therapists utilize a family-centered approach in all assessments and interventions to assure
collaborative partnership with a child’s parents/guardians. Collaboration with other professionals may
include: physicians, nurses, teachers, social workers, speech therapists, physical therapists, nutritionists,
and any other personnel working with the child.

OT Contributions to the Interdisciplinary Process

- Occupational therapists may participate in co treatment sessions with SLPs and PTs in a clinic or school
setting.
- Occupational therapists may serve on a student’s IEP team and work with other team members to
develop and support student goals in the school setting.
- Occupational therapists work closely with SLPs, PTs, MDs, nurses and other professionals in rehab
settings.
- Occupational therapists provide information about a student’s motor, play, and sensory processing skills
to help the interdisciplinary team determine a diagnosis.

When should you refer a child for Occupational Therapy?

Reasons You Might Refer A Child For Occupational Therapy:
• Poor sensory regulation and organization
• Delayed gross and/or fine motor skills
• Poor pre-writing and handwriting skills
• Difficulty with motor planning and sequencing
activities
• Delayed or limited repertoire of play skills
• Poor oral-motor control for feeding (sucking,
chewing, swallowing)
• Delayed or limited self-care skills (i.e., managing
clothing fastenings, self-feeding, preparing a
simple snack, managing money)
• Limited social skills or behavioral-adaptive skills
(i.e., coping skills, establishing friendships,
cooperative play with peers)

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 UW LEND – Occupational Therapy Module

Case Study – Early Intervention

Meet Sam
Sam is 2 ½ years old with developmental delays in communication, play, and
adaptive skills. Sam was referred for OT services 6 months ago. His parents were
concerned that Sam’s play with toys was limited with a preference for watching
wheels spin on his car toys, fearful and cautious participating in activities in the
community toddler gym, cries and runs away in response to sudden loud sounds
like a vacuum or lawn mower, refuses face washing and tooth brushing, and often
tantrums and cries inconsolable during errands in the community.

Occupational Therapy Goals

Long Term Goal Short Term Objectives

Sam will play with a wider Sam will:
variety of toys  Drive cars along play mat down block ramps and bridges
 Play with play dough; rolling the dough and cutting shapes with cookie
cutter
 Engage in pretend play with play food and dishes
Sam will participate in a greater Sam will:
variety of motor activities at his  Complete a three part obstacle course with minimal assistance
toddler gym class  Climb up a 4-step ladder on a slide with no assist
Sam will tolerate having his teeth Sam will:
brushed and his face washed  Wipe his mouth and face by himself with a damp washcloth after at
least one meal
 Bring a tooth brush to his mouth and teeth himself
 Bring a vibrating brush/toy to his lips and cheeks
Sam will complete a 30 minute Sam will:
trip to the grocery store without  Parents will use anticipatory guidance strategies, such as the grocery
crying or upset store social story, to prepare for the errand
 Sam will sit in the grocery store cart with a favorite book or toy for at
least a 15 minute errand in the store

Intervention:
Sam receives weekly occupational therapy services to address his play skills, sensory processing differences
and emotional regulation. Therapy is play-based with an emphasis on expanding play skills and interests
and improving body awareness and motor planning. The occupational therapist works with Sam’s parents
to develop strategies to help Sam manage sensory experiences such as loud noises, teeth brushing, and
face washing.

Outcome:
After six months of occupational therapy, Sam is exhibiting a wider range of play interests and is starting to
engage in pretend play. His parents report that Sam is less fearful in his toddler gym class and is
participating in more and more activities every week. Sam now washes his own face and allows a parent to
help brush his teeth. The family has learned strategies to prepare Sam for community outings and Sam is
showing increasing ability to manage short errands without tantrums.
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 UW LEND – Occupational Therapy Module

Case Study – School Setting

Meet Violet

Violet is a 12 year-old middle school student with a complex medical history. She presents with a
global developmental delay and optic nerve atrophy and recently underwent spinal fusion surgery.
Since her surgery, she has decreased range of motion in her right shoulder and vertical nystagmus. As
a result, she is using her right arm less than she used to and has difficulty tolerating lying on her back
and lying on her stomach.

Goals:
1) Preacademic: When given appropriate positioning and adaptive tools Violet will participate in
classroom art projects.
2) Adaptive/Life Skills: When given her spoon with a bite of food Violet will put her spoon in her mouth
and remove it on her own.
3) Communication: When given an iPad communication activity Violet will press the desired button on the
app.

Intervention:
Occupational therapy services were provided as a combination of direct service for Violet in her
classroom and consultation with parents, teacher, classroom staff and other service providers.
Examples of intervention strategies:
• Provide functional activities to practice finger isolation to help support communication goals
• Determine appropriate positioning and adaptive tools for Violet to participate in art activities, taking
into account vision, motor, and pain limitations
• Trial different types of adaptive
bowls and spoons to determine
which promotes greatest
independence with feeding

• Provide skilled instruction and practice in using a pincer grasp for more efficient self-feeding
• Trial and acquire appropriate positioning equipment such as a wedge to increase comfort while lying
on back and stomach.

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 UW LEND – Occupational Therapy Module

Case Study – Consultation in the Community

Staff and administrators at the Pacific Science Center in Seattle, Washington requested help from
occupational therapists to improve the accessibility of the Center to children with autism and/or sensory
processing differences and their families.

Goal:
Adapt the sensory environment and create tools to increase accessibility of the Pacific Science Center to
children with autism and/or sensory processing differences and their families.

Intervention:
A team of Occupational Therapy students and faculty mentor developed tools that families and Pacific
Science Center staff could use to assure a fun experience that was accessible and not overwhelming for
young children with autism or other sensory processing differences. This work included meeting with
science center staff, focus groups with parents of children with autism, and informed observations of
children with autism in their school setting. As a result social and environmental supports were created for
the Pacific Science Center:
• Adventure Planners: provide descriptions of exhibits and expected behavior during a visit to the Pacific
Science Center
• Sensory Guide: describes sensory characteristics of each exhibit to help families plan their visit
• Picture Schedule: specifically designed for use at the Pacific Science Center
• Tips and Tools for Parents

Resources on Pacific Science Center Website

[Link]

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 UW LEND – Occupational Therapy Module

Resources

For more information about occupational therapy

• American Occupational Therapy Association - [Link]
• Washington Occupational Therapy Association -[Link]

Video: Samples of OT Intervention in Action

How occupational therapy helps with sensory integration issues
[Link]

Improving Fine Motor Skills with Occupational Therapy

[Link]
(this would also be a good case study)

The following Resources used to create this module

American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain
and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1-S48.
[Link]

Case-Smith, J., & O'Brien, J. C. (2010). Occupational Therapy for Children. Maryland Heights, Mo:
Mosby/Elsevier.

Crepeau, E.B., Cohn, E.S., & Boyt Schell, B.A. (Eds.). (2008) Willard & Spackman’s Occupational Therapy.
Philadelphia: Lippincott Williams & Wilkins.

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 UW LEND – Occupational Therapy Module

Credits and Acknowledgements

The curriculum for the occupational therapy module was developed by:
• Jennifer Leichtman, MS, OTR/L
Occupational Therapy UW LEND Fellow
CHDD, University of Washington
• Susan Wendel, MS, OTR/L
Occupational Therapist
CHDD, University of Washington
swendel@[Link]

Return to UW LEND Modules webpage

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