OT (Occupational Therapy)

3. Motor Planning - Ability to imitate body position. Integrate both sides of body, sequence of movements, create/assemble objects parts to whole. Plan/execute drawings/designs. Act upon verbal commands. Control & coordinate oral movements.

5. Activities of Daily Living - Performance of daily living skills (feeding, dressing, toileting, play & schoolwork). Motor planning abilities for sequencing of self help tasks. Individual problem solving/decision making.

6. Assistive Devices & Environmental Adaptations, adapted materials &/or teaching strategies, selection of appropriate equipment and/or positioning to facilitate postural control & independence in daily living activities, and recommendations regarding architectural barriers.

7. Classroom/ Environmental Modifications

8. Social Play/ Organization of Behavior 

Most kids on the spectrum benefit greatly from good OT. The district may try to convince you otherwise.

Who provides Occupational Therapy
 

i. Private OT

• Costs around $110-$125/hr.
• Most recommend frequency of 1-2x/week.
• Clinic Based OT: Advantage: they have all the specialized equipment esp for sensory integration etc on site.
• Home based OT: The OT will come to your home. Advantage: less travel time, less hassle & depending on the needs of your child it may work out better. Disadvantage: some OTs expect you to put reinforcing beams in your garage & buy some of the equipment - can be expensive. (Again this depends on needs of your child)
• Need for Evaluation: When you go to a private OT, they will again ask you to do an initial eval. This can be costly (around $500-1000).
• Private OT’s usually do a pretty through eval and so their report should be very informative. (Districts/SARC also do an initial OT eval but my kid’s report was only 2 pages long & did not really tell me much)
• If your child is newly dx, a detailed report may give you a good benchmark to monitor progress later.
  If you can to use the report to make district to pay for services (if you can), then worth it.
  If you can use the report to get the school OT to address the issues in the report – then worth it.
  For a child who’s been around for a while it may not be necessary for you to spend for a report that is going to sit in a file. Instead request if the OT could just work with your child and in the process find out the areas the child needs work on rather than doing a expensive evaluation up front.
• Working with a private OT also makes you more aware of the areas that your child is deficit in & you can use this to request these from the district
  Quality of private OTs also vary so do not waste your time/money on ineffective OT's - you will know after a couple of sessions as to whether it will work for your child or not.
• How do you find a good OT? - network - poll other parents to find out who has been effective for their kids. Get on their waiting lists.
  Some insurances cover your private OT
   

ii. District OT

• You can usually get OT from the district at the preschool level fairly easily. Once they are beyond 5, the law says that the school OT (if needed) need only address needs in the classroom (which translates into classroom consultation with teacher) & the school is not responsible for areas outside the school environment.
• Unfortunately most of our kids do need help across environments. It takes a lot of convincing to get even classroom OT consultant once the kid is over 5.
• Make the most of the school OT at the preschool level - ask questions & be very involved in therapy & follow through all activities. Later what happens with OT services in the classroom may be one giant mystery.
• Again the quality for services differ widely between district & private. The case load for school OT’s is tremendous. In our district for example 1-3 OT’s handle the entire district/SELPA’s kids.
• District is not obliged to give you an experienced OT. So quality may/may not suffer. Of course if the OT has been around for a while with the district, she has learnt on the job.
   

Resources  

Books

1. SenseAbilities – Understanding Sensory Integration by Maryann Colby, Marci, Laurel & Susan Windeck
2. The Weighted Blanket: An Essential Nutrient in a Sensory Diet by Diane B. Walker, M.S., OTR/L and Kathleen McCormack, 2002 - book to teach parents and therapists how to make and use a therapeutic weighted blanket. Part One describes the theory regarding the use of the weighted blanket as a therapeutic modality for the treatment of Sensory Integration Dysfunction (SID). Includes clinical stories and a protocol for use of the weighted blanket in various settings (home, school, clinic) including use schedules, weight distribution, and precautions. Part Two provides the step-by-step, easy to follow sewing instructions and fabric selection. The appendix contains many helpful worksheets, such as A Sensory Checklist to determine whether or not to use a weighted blanket and A Weighted Blanket Usage Chart. 

Tips: 

• Therapy Balls are cheaper if bought at sports stores or toy stores than in the catalogs.
• You can make a lot of the material yourself (where possible for sensory integration especially ) as items in the catalog can be expensive.
  
• Ideas from other parents on making various products

Making your own weighted blanket 

Please consult an OT on need & use of weighted blanket so that it is tailored to your child.

Making the blanket
Use two existing blankets to do this. Put the pockets on one, and then sew the two blankets together. This way also the pockets can be sewn out of any material, and no one will see what they look like. The pockets should be large to accommodate the child’s growing needs. Sow the pockets on 3 sides only. Sow Velcro on the inside of the pockets so that you can attach the weight bags as needed. The baggies can be adjusted according to how much pressure is needed. The blanket is washable as you can take out the weights.

OR Make blanket and a weighted vest using regular patterns and by creating little pockets throughout each.

OR Make the weighted blanket from a Velux blanket cut to size width wise. Fold it in half and sow the length of the blanket every four inches. Pour little plastic pellets that you can buy at a craft store into the four inch pockets. Sew the pockets closed.

Weights:
- dried peas
- flaxseeds (inexpensive, safe, conform to the body)
 

Sensory Integration

Sensory Integration: The relationship between behavior and brain functioning. The SI theory was pioneered by A.Jean Ayres Ph.D OTR in the 1960s. 

Our body's senses detect sight, sound, smell, taste, temperature, pain and position and movements of the body. The brain uses this information to form a combined picture in order for the body to make sense of its surroundings and act accordingly. However with our kids with Autism, the brain is often unable to integrate information received from the body's  senses. 

The neurological disorganization occurs in 3 ways a. brain does not receive messages due to a disconnection in neuron cells b. sensory messages are received inconsistently c. sensory messages are received consistently but do not connect properly with other sensory messages.  The result is inefficient motor, language or emotional output. 

• oversensitivity to touch, movement, sights, or sounds
• underreactivity to touch, movement, sights, or sounds
• tendency to be easily distracted
• social and/or emotional problems
• activity level that is unusually high or unusually low
• physical clumsiness or apparent carelessness
• impulsive, lacking in self-control
• difficulty in making transitions from one situation to another
• inability to unwind or calm self
• poor self concept
• delays in speech, language, or motor skills
• delays in academic achievement

Proprioceptive:  pertains to proprioception, or the awareness of posture, movement, and changes in equilibrium and the knowledge of position, weight, and resistance of objects as they relate to the body.

Tactile : The perception of touch.

Vestibular : Pertaining to the vestibule; regarding the vestibular nerve of the ear which is linked to the ability to hear sounds.  

Sensory Integration Questionnaire