18 Applications in OT Contexts

Oriahna Nueske

Clients would much prefer instant, dramatic levels of change and improvement, but many therapeutic outcomes are reliant on client participation. Encouraging learners to actively engage with the material and challenge themselves to improve can be a difficult task in any setting. Some occupational therapies naturally lend themselves into feeling like fun playtime activities, only requiring small, natural feeling interventions from the therapist. Fine-motor skills development therapies can present in the form of drawing, painting, and coloring. An occupational therapist can guide a child to slow down, hold their coloring apparatus a more effective way, or ask them to trace and copy shapes to improve strength and coordination. Some therapies are more difficult to present as fun or interesting, but therapy presentation is one of the deciding factors of student participation.

Different health conditions require different interventions, but overall the goal of an OT is to help a student reach an occupational goal they have been struggling to meet. Very young children and clients with delayed or diminished neurological processes may not be able to self-regulate effectively, and so their care plans will have to involve regular guided sessions by the OT. Some students can be given instructions and guidance towards reaching their goals, with the intention of establishing a behavioral baseline for them to self-regulate as therapy progresses. Under-developed self-regulation habits can be gently guided by the therapist with a little scaffolding over time in the therapeutic relationship. While early therapeutic sessions should be guided with careful instruction to build this behavioral baseline, these behaviors can’t remain segregated to the therapeutic environment. Students need to be able to practice learned behaviors and skills in naturalistic settings, and that requires some cognitive self-regulation (Cleary & Zimmerman, 2012).

A good start for any therapeutic relationship is to set some clearly defined goals (Cleary & Zimmerman, 2012). It may feel repetitive after the first few sessions, but clearly defined goals make it easier for both clients and therapists to track progress. Therapists should set goals based on individual needs and health conditions, but these goals should be presented in a way customized to the client’s interests. An OT will need to match their professional goals to the client’s personal goals. If a client has not yet developed the ability to communicate their interests with language, use language alongside guided and sensory based-exercises that involve sights, sounds, scents, and textures.   If your client is able to use language to communicate, try to establish a growth mindset when you ask the client about their interests and goals by using action-based terminology and gently re-directing them from static terms (Cleary & Zimmerman, 2012).

Instead of asking the client what they want to be, ask them what they like to do, or what they would like to do someday (Lei et al., 2019).  Make sure the effort-cost of OT aligns with a utility they feel invested in order to maintain motivation. If your client likes cooking you could adjust strength and control exercises to match up with motions of stirring, chopping, and peeling foods. If your client wants to ride a horse someday you can make a relatively uninteresting grip exercise into training for when they have to hold a horse’s reins someday. Ensure your applications feel authentic to encourage flow, you don’t want client’s grudgingly going through perfunctory motions. If a client is stagnating on a task, maybe revisit goals and diversify potential therapeutic applications . Regardless of client interests, try to create a diverse repertoire of potential therapeutic exercise applications (Tomporowski & Pesce, 2019). You want actions to be repetitive enough to build natural feeling behaviors, but diverse enough to hold student interest and maintain an embodied learning structure. Embodied learning, combined with repetition enables the growth of stronger, more complex neural networks within the brain, allowing for stronger and faster memory reconstruction in future contexts.

Each session should end with a review and reminder of therapeutic homework. Depending on age and personal ability level, set up a plan to track client progress at home and in the classroom. Recommend a number of times behaviors should be practiced at home, including how long these behaviors should be practiced (Tomporowski & Pesce, 2019). Demonstrate a strength/control exercise for a student, then give an appropriate homework allowance. The timing and amounts will vary wildly between students but an example of this would be to ask them to perform this motion three times a week for the whole duration of their favorite song. Encourage the child and/or their caretakers to make a note every time the student does their therapeutic homework. Young children can use stamp tables, and older clients can keep a therapy journal to write down when they do their homework and any notes they notice on their progress.

A record of outside-session behaviors and progress can be especially helpful for an occupational therapist. Information like when the student is practicing, how often the student is practicing, and any painful or unusual feelings the child experienced with the exercise can be useful both in adjusting care-plans and in giving constructive feedback. Cognitive self-regulation is something you have to kick-start in a learner, by helping them to differentiate between behaviors that are effective and less effective at helping them reach their goals (Cleary & Zimmerman, 2012). If age and personal ability allow, try to combine action-terminology with the Socratic method to guide clients towards cognitively differentiating their behaviors. The act of outright telling a child that practicing regularly helps improve their outcomes has a much weaker effect than allowing the child to figure this out on their own. This method of therapy helps the child to develop a sense of autonomy and self-worth while encouraging them to self-strategize which behaviors will be most helpful in seeking their goals.

Students will experience a multitude of different learning expectations with lessons they will be required to memorize, understand, and extrapolate on. Learning in a therapeutic context may feel different than learning in a classroom, but a lot of the same practices of scaffolding a supportive, embodied learning experience are the same. Occupational therapy learning expectations tend to lie mostly in the realm of skill acquisition. Skill acquisition learning comes in stages (Tomporowski & Pesce, 2019). The cognitive stage involves students being introduced to a task, and attempting movements associated with that task. The associative stage consists of repeated practice of movements associated with a task while adapting to slight modifications in timing and context. Students in the associative stage of skill acquisition have a general idea of what the skill is they are practicing and how to practice it. The skill acquisition path is cognitive, but the goal is for students to use the skill as an automatic action in future contexts. A student with a refined, automatic use of the skill is in the autonomous stage of skill acquisition).

Occupational therapy can be a smooth and pleasant experience that some clients won’t even register as “work”. Sometimes OT can be a much more complicated and difficult journey. Try to plan your sessions toward activating your client’s cognitive self-regulation (Tomporowski & Pesce, 2019). Set realistic goals that are interesting and personal for the client (Lei et al., 2019). Track client progress, and help them learn to track their progress effectively. Give supportive feedback, and encourage them to strategize around when and how to practice their skills(Cleary & Zimmerman, 2012). It is important for clients and OTs to understand that the purpose of OT is not for clients to struggle and force themselves towards traditional milestones of ability and independence. The purpose of OT is to set clients up for a happy life while supplying them with any internal and external supports they might need to navigate their path.

References

Cleary, T. J., & Zimmerman, B. J. (2012). A cyclical self-regulatory account of student engagement: Theoretical foundations and applications. In Handbook of research on student engagement (pp. 237-257). Springer, Boston, MA.

Lei, R. F., Green, E. R., Leslie, S. J., & Rhodes, M. (2019). Children lose confidence in their potential to “be scientists,” but not in their capacity to “do science”. Developmental Science, 22, https://doi.org/10.1111/desc.12837

Tomporowski, P. D., & Pesce, C. (2019). Exercise, sports, and performance arts benefit cognition via a common process. Psychological Bulletin, 145(9), 929.https://doi.org/10.1037/bul0000200