OT in a Nutshell

You wouldn’t be the first person to wonder what Occupational Therapy is all about.

As Occupational Therapists (OT’s), we get asked about what we do all the time: “Are you a bit like a Physio?” or “Do you put hand-rails in people’s homes” or “OT’s don’t do mental health do they?” – these are just a few questions we get asked and we often smile. The name “Occupational Therapist” is inherently confusing if you don’t really know what we mean by “occupation” and how this is linked to “therapy.”

So, let’s look at this. When meeting a client, we start out by looking at the occupations they are currently doing or expected to do. For children, they have the broad categories of “work” – which in their case is to go to school and be a student, “self-care and self-management” – which is looking after themselves with various levels of independence in lots of different environments, and “play/leisure” – their time spent learning about the world and others through creative, unstructured or structured activities. Within each of these areas, all children have roles, such as being a friend.

As OT’s, we look at a child’s functioning within each of these broad occupational areas and notice if there are any difficulties or issues within each. These are often the reasons why children come to OT – for example, it might be they are having difficulties with friendships, difficulties remembering things in class, finding it hard to get dressed by themselves, problems getting their work finished on time, or difficulties staying calm at home or falling asleep.

This is where OT gets really interesting. We are trained to look “beneath” these presenting difficulties and use our training and skills to uncover the underlying reasons for these problems. Our scope is broad, so that we can look at all factors that might be contributing to these difficulties. We call these “performance components” when we look at the different skills and factors needed to perform a task successfully.

So let’s take an example of an 8yr old boy, Benjamin, who is getting really upset at recess and lunch time every day.

Through conversation, it becomes clear that Ben really likes playing soccer. However, he is getting really upset when he tries to play with friends, and it is becoming the source of lots of conflict as well as distress at school. He is getting in trouble for losing his temper, kicking the ball away from the field and into trees on purpose, as well as losing friends. Because we are trained in a broad range of areas, we can assess all the possible reasons which might be contributing to this issue. Once we have identified these factors, we can then get to work addressing each.  The overall goal being to improve Ben’s functioning and his ability to join in and play soccer happily with friends at school (‘the occupation‘).

Playing soccer is really important to Ben. Let’s look at some of the potential reasons why this may be an issue for him and what OTs would be assessing to determine these.  And then we can get stuck into working on ways to improve this area for Ben. This is a good time to call on our knowledge base and training as OTs:

“Occupational Therapists use a knowledge base of neurology, anatomy, physiology, kinesiology, child development, psychology, psychosocial development, activity-task analysis and therapeutic techniques. They are trained to treat clients holistically, addressing their cognitive, emotional and physical needs through functional, activity-based treatment” (Williams and Shellenberger, 1996, p.5-6).

First, we would look at “physical” – what are Ben’s movement skills like? Does he have good balance and coordination? Is he able to run, change pace and direction quickly? Does he track the ball with his eyes? Can he calibrate force, timing, and effort in his movements? Are his muscles strong enough? Does he fatigue early? Does he have good range of movement and muscle tone? Does he have enough agility and fitness to keep up?

Then we look at “cognitive” – does he understand the rules of the game? Is he able to stay focused and concentrate on the game? Is he able to process information quickly from what he is hearing, seeing and doing? Is he able to problem solve when things don’t go to plan? Can he be flexible enough to move on when things don’t go his way?

Then we look at “social and emotional” – does he understand the implicit rules of playing soccer with friends rather than in a competition? Is he able to communicate his needs assertively and calmly? Is he able to interpret other’s behaviour correctly? Is he able to distinguish between friendly vs mean teasing when playing? Does he know how to compromise or wait? Can he manage his impulses when upset? Does he have enough confidence to speak up or ask for help? Is his mood relaxed or does he feel irritable and anxious? Does he have enough motivation and drive to persevere when feeling challenged? Is he sensitive to how other’s judge him if he isn’t very good or good enough? Does he get embarrassed quickly in front of others? Is he perfectionistic and finds it difficult to accept losing or that others may be better than him? Does he lack self-esteem and feels that everyone is better than him at everything? Does he become quickly negative and act in ways that are unhelpful? What messages does he get from parents about playing soccer? Is there a family culture of being good at things or needing to achieve? Are there opportunities for him to talk about his feelings at home and feel supported?

As you can see, there are so many reasons that could potentially be uncovered here for Ben. Once we have “ruled out” reasons, and we have used our assessments to “rule in” reasons, we can begin to work on each factor in a clear and sequential way. Often, we find that there are several reasons that all combine to make a task tricky. And often, these underlying reasons are also impacting on other areas of functioning – creating difficulties elsewhere too. By working on these components, it will also help in other aspects of his life!

So yes, we could be a bit like a physio, as well as a psychologist or coach. It depends on the unique factors for each child. As OTs we are armed with a holistic lens and ability to “go there” with each possible factor impacting on his performance.

So that is OT in a nutshell!

Wondering how we apply this practice to your child or relative? Please feel free to view our Menu of Services.

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