Occupational Therapist Health Article

Occupational Therapist

A professional who promotes health, enhances development, and increases independent functioning in children and adults through activities involving work, play, and self-care.

Occupational therapists help persons with both physical and emotional problems as well as learning difficulties. Although occupational therapy was initially associated with reintegrating veterans of World Wars I and II into the work force, the term "occupation" used in the context of this profession actually refers to any activity with which persons occupy their time, including—for children—play and school.

Occupational therapists undergo a rigorous training program. Four-year undergraduate programs, offered by many institutions, include courses in anatomy, psychology, and the theory and practice of occupational therapy. In addition, occupational therapists must complete six to nine months of clinical training. After graduation, most take a national examination to qualify as a Registered Occupational Therapist (R.O.T.). Occupational therapists work in various settings, including hospitals, nursing homes, rehabilitation centers, schools, day care centers, and patients' homes.

It is estimated that as many as 35% of occupational therapists work with children, many receiving specialized pediatric training in graduate programs. Much occupational therapy with children is based on giving children the physical, mental, and emotional benefits of performing various activities by turning them into play. For example, a special safety seat can help a previously resistant infant enjoy splashing and playing at bath time. One occupational therapist has gotten older children to enjoy being sprayed and scrubbed by devising a "car wash" for them to crawl through, complete with a "hot wax" lotion.

A pediatrician can often help parents choose an occupational therapist for their child. Before therapy can begin, the therapist evaluates the child through observation, discussion with parents, and, often, special assessment tests such as the Bayley Scales of Infant Development or the Knox Play Scale. Occupational therapists generally use one of two major treatment approaches with children: developmental or functional therapy. Developmental therapy is geared toward helping children achieve normal developmental milestones. A commonly used traditional method associated with this approach is neurodevelopmental therapy (NDT), which was developed in the 1950s by a neurologist and a physical therapist. It helps children with disorders, such as cerebral palsy, that affect muscle tone, making muscles either too tight (spastic) or loose and floppy (hypotonie). Treatment involves helping parents handle children with such disorders in ways that promote more normal muscle tone and helping the children themselves develop healthier, less restricted movement patterns. Occupational therapists are trained in NDT as part of their formal studies, although many of those specializing in pediatric occupational therapy receive additional training, including an eight-week certification course offered by the Neurodevelopmental Treatment Association.

A newer approach to developmental occupational therapy is the sensory integration method developed in the 1960s by Dr. A. Jean Ayres. Sensory integration is based on the idea that certain types of developmental problems are caused by neurological difficulties in processing information taken in by the senses. Usually used to treat children with learning disabilities, it has also been effective for other types of disorders, including cerebral palsy and autism. This approach concentrates primarily on three senses: touch and two that are not among the commonly listed "five senses"—the vestibular sense and proprioception. The vestibular sense, regulated by fluid levels in the inner ear, controls bodily movement and is important in balance and coordination. Proprioception, which is closely linked to the vestibular sense, is the perception of one's body position—the sense that allows people to touch their noses or comb their hair. Difficulties with sensory integration are most often caused by problems with the central nervous system and may appear as over- or under-sensitivity to touch, problems learning new sensorimotor skills, language delays, or an abnormally high or low level of activity.

The idea behind the sensory integration approach is to improve the way sensory messages are processed by the brain through activities that require a child to provide a specific reaction to controlled sensory input. Therapy sessions are usually scheduled once or twice a week for six months or more. There is still controversy surrounding the effectiveness of sensory integration therapy, and many pediatricians are not aware of this approach. A special organization, Sensory Integration International in California, works to promote awareness of this therapy. Occupation therapists often use it in conjunction with other techniques as part of a more comprehensive therapeutic program.

In contrast to developmental occupational therapy, functional therapy concentrates on teaching a child self-care activities, such as eating and dressing. Within this pragmatic context, however, therapy encourages children to develop new skills and practice the ones they already have. Special devices often aid in this process, such as splints to position parts of the body to function as effectively as possible, or such devices as a dish with a nonslip bottom that can't slide away from a child who is working on using a spoon properly. Physical problems commonly addressed in functional occupational therapy include limited motion, weakness, and lack of endurance; weakness on one side of the body; and poor coordination. This type of therapy is also used to increase the independence of the mentally retarded and help blind children master their environment.