Chapter 33
Occupational and Physical Therapy
•Role(s) of occupational and physical therapists
•Common intervention frameworks and applications to children of different ages/disabilities
•Intervention strategies to enhance skill development and increase participation
Enhance participation
Teach new skills
Improve physical function
Prevent possible future limitation
Team approach:
Therapists and families; variety of settings
Skill development:
Occupational: upper extremity/fine motor
skills
Physical: lower extremity/gross motor skills
Main Goal: meaningful life outcomes
Therapy Types and Purposes
Rehabilitation:
Increase functional/developmental abilities
Reduce limitations
Increase range of motion; decrease sensory defensiveness
Support skill learning
therapies
Full participation/inclusion
Enhance participation in activities and routines in home, school, community
Outcomes:
Successful participation in home routines, school activities
Intervention Frameworks
Rehabilitation/traditional framework
Identifies need
Provides intervention (targeted exercises)
Participation-based framework
Focus: inclusion, typical settings
Address social/physical aspects of environment (ramp, furniture arrangement)
Embed interventions into family/school activities
Team Structures and Therapist Roles
Evaluate performance, provide intervention
Team approach
Different team structures
Transdisciplinary
Integrated
Collaborative
Single service provider
Role of Therapists
Evaluation and assessment
Depends on age/setting
Formal tests/instruments
Assess motor skills: endurance, efficiency, speed
Family/teacher-completed checklists
Measure baseline performance
Participation-based: observations, interviews
Participation measurements
Intervention planning
Individualized family service plans, individualized education programs, 504 plans, individualized habilitation plans
Remedial focus: identify need, then design treatment to improve targeted skill; therapist-designed activities
Participation focus: integrated assessment of skill, structure, participation to reduce impact of limitations on participation; existing activities/routines
Implementation
Many settings: hospital, clinic, school, home
Traditional: therapist plans, selects, provides activities
Participation: activities embedded in daily routine
Progress monitoring
Tracking performance and outcomes
Intervention Strategies
Basic categories:
- Strategies requiring adult implementation
- Environmental strategies (adaptations, assistive technology)
- Custom intervention strategies
For children with low incidence disabilities additional training may be necessary
Neurodevelopmental therapy, craniosacral therapy, myofascial release therapy, and others
Evidence-Based Intervention
Based on evidence of appropriateness and effectiveness
Sources of evidence:
Research studies
Policy/experiential knowledge
Traditional → designed, direct interaction
Participation-based → embedded activities
Evidence-based strategies