MaternalMusing

A Personal Adventure Into Parenthood

Occupational Therapy: Step One – The Assessment July 13, 2015

After requesting an Occupational Therapy consult through our family health team in early June we finally got the call with about two weeks remaining in the school year. I was pretty pumped to get a jump on V’s needs for Senior Kindergarten and the therapist seemed very thorough and kind, even on the phone!

She started by asking me what our concerns were with V and why we’d requested the consult. She listened actively which was a relief, since I originally felt pretty brushed off by our family physician. The therapist immediately recommended that I contact the school and request that V had Physiotherapy set up for Sept, as soon as school starts.

Her reasoning was two-fold:

One – V falls a lot, and since the school is aware that this happens, it is a liability for them if he falls, injures himself and they’ve done nothing to assist him. PT will help his gross motor development and hopefully have him running, jumping and generally keeping up with his peers in the playground/gym class.

Two – The wait list for Physio is much MUCH shorter than the list for Occupational Therapy in the school system. There are fewer students with gross motor development needs and teachers are less aware that Physio is even an option in their classroom. As adults we typically only consider Physio in the context of injuries and rarely in relation to developmental issues.

V’s teacher is an amazing educator and truly cares for her students. I let her know the Occupational Therapists recommendation and the paperwork for V’s Physio in the fall had been submitted and approved by the end of the week! One thing check off our list for back to school!

The Occupational Therapist then scheduled our first visit so that she was able to evaluate V’s skills in person. She let us know that she would likely need two visits; one to evaluate and one to impart a treatment plan, and they would be about an hour apiece.

We prepped V for the appointment by letting him know we’d be going to see a fun ‘doctor’ who was going to play some games with him. 4 year olds don’t distinguish between different medical professionals and since it was at our dr’s office…they’re all doctors in there! He was excited to go visit.

At the first appointment the therapist did several exercises with V to evaluate his hand strength, coordination and writing abilities. Some of the activities were:

Cutting:

  • Cutting along a straight line (about half a page in length) with basic school scissors. She had him try to hold the paper and cut, and then she held the paper while he cut.
  • Cutting around a right-angled corner with basic school scissors. She held the paper, then had him hold it, then she used coloured markers to mark where each of his fingers should be when holding the paper while he cut.
Scissors worksheet example. Before the exercise.

Scissors worksheet example. Before the exercise.

Trying to coordinate the scissors and his holding hand to cut a straight line.

Trying to coordinate the scissors and his holding hand to cut a straight line. Also note that although he is left handed, he manipulates the scissors with his right hand.

End result of the scissors exercise. You can see that he can't cut a smooth or straight line right now.

End result of the scissors exercise. You can see that he can’t cut a smooth or straight line right now.

Writing:0

  • Tracing between two lines in different shapes using a pencil. He had to trace between two straight lines, two lines with sharp V-like corners, and two wavy lines.
  • Tracing on top of lines using a pencil. Again she had him trace straight, sharp curves and wavy lines.
  • Pre-writing exercise by copying basic shapes: cross, x, square, circle, triangle.
  • Copying the writing of his own name. She had him trace over-top of her writing and then try to copy it by himself.
Line tracing exercise. The large gap between the lines is because we want him to experience success. The width will decrease over time.

Line tracing exercise. The large gap between the lines is because we want him to experience success. The width will decrease over time.

Note the bizarre, fist-type grip he uses because his fingers aren't strong or coordinated enough yet.

Note the bizarre, fist-type grip he uses because his fingers aren’t strong or coordinated enough yet.

End result of the lines exercise. Notice there isn't a lot of movement if he can help it.

End result of the lines exercise. Notice there isn’t a lot of movement if he can help it.

At the end of the exercises she gave us a quick evaluation of what she’d seen. In V’s case she let us know that he has minimal fine motor skills and we’ll need to start right at square one to help him build up to where he needs to be by the time he enters Grade 1.

Pre-writing exercise. V needs to copy the shapes as close as he can in the boxes to the right.

Pre-writing exercise. V needs to copy the shapes as close as he can in the boxes to the right.

Examining his work. This one frustrates him the most.

Examining his work. This one frustrates him the most.

Pre-writing results. Notice that his shapes lack definition and tend to be pretty similar. They will improve as he learns to stabilize and control his pencil.

Pre-writing results. Notice that his shapes lack definition and tend to be pretty similar. They will improve as he learns to stabilize and control his pencil.

V has little to no co-ordination in his hands. He struggles to even open and close the scissors in a cutting motion, let alone have the ability to cut along a line or co-ordinate both hands to hold and cut. V is also left-handed but cuts with his right. The OT told us this is very common in school aged kids because there are rarely, if ever, left-handed scissors consistently available in the classroom. We aren’t going to try to modify this…he’ll be a left-handed writer, and right-handed scissor wielder!

Writing exercise. He needs to trace his name and then try to copy it independently.

Writing exercise. He needs to trace his name and then try to copy it independently.

Funny grip again! He really enjoys trying to write his name though. He's almost got the V down.

Funny grip again! He really enjoys trying to write his name though. He’s almost got the V down.

Writing results. We definitely have a few steps to go before he's able to write legibly.

Writing results. We definitely have a few steps to go before he’s able to write legibly.

As for writing he has no consistent pencil grip. He alternates from a fist, to a modified three-point grasp, to a bizarre grasp stabilized by his middle finger along the length of the pencil. This stems from the fact that he can’t coordinate his fingers so that the far fingers are stabilizing his hand and the inner fingers and thumb manipulate the pencil. His whole hand works as one whole grasp. We’ll need to help him learn to co-ordinate his fingers and find a proper grasp before we can even move into tracing and pre-writing. The goal is to have him writing his name at the end of the year. There is no rushing this type of thing. We want him to learn consistency and co-ordination, not shortcuts to create the appearance of him learning.

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One Response to “Occupational Therapy: Step One – The Assessment”

  1. Tamrah Says:

    fascinating read 😊


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