1. Occupational Therapy in Learning Disabilities Rajani Kelkar Program Ummeed Child Development Center, Mumbai

2. 2 Occupational Therapy □ Is health profession concerned with how people function in their respective life roles and perform everyday activities □ In children the life roles & activities include  Academic activities  Functional skills  Socialisation & Play

3. □ Child and family centered practice □ Comprehensive evaluation □ Effective intervention  Through various media & modalities 3 What do Occupational Therapists do?

4. 4 L D - OT Perspective (1) □ Group of problems affecting child’s ability to  Master school tasks  Process information  Communicate effectively

5. 5 L D - OT Perspective (2) □ Often associated with other neurological problems  ADHD  Auditory processing difficulties  Visual Perceptual impairment

6. L D - OT Perspective (3) □ Learning disorders are caused by a difference in the brain that affects how information is received, processed, or communicated. □ Children and adults with learning disabilities have trouble processing sensory information because they see, hear, and understand things differently.

7. 7 Behaviours Displayed by LD Child □ Gross & fine motor dysfunctions □ Educational Disorders □ Disorders of attention & concentration □ Disorders of thinking & memory □ Problems with speech & communication □ Auditory processing difficulties □ Sensory integrative & perceptual disorders □ Psychosocial problems

8. 8 Assessment -What and How (1) □ Interview □ Formal assessment tools- examples  Peabody Developmental Motor scales  Tests of visual motor skills  Tests of visual-perceptual skills (non-motor)  Sensory profile  Handwriting scales  Social skills rating system  Play scales

9. 9 Assessment -What and How (2) □ Observation and assessment of  Behavior  Occupational and other life skills  Family dynamics and environment □ Informal assessment through the use of activities

10. 10 Brain can change □ Premise of OT intervention based on concept of Neuroplasiticy  Natural life long ability to form new connections  Generate new brain cells in response to experience & learning ( Doidge, Norman, 2007)

11. 11 How does understanding brain help with learning disability? □ Faulty wiring in brain disrupts normal lines of communication and makes it difficult to process information easily. □ Under right learning conditions, brain has ability to reorganize itself by forming new neural connections. □ New connections facilitate skills like reading and writing that had been difficult using old connections.

12. 12 Fine Motor Activities to Improve School Functions (1) □ Strengthening  Hide & find tiny pegs, beads, marbles in putty  Crumble paper to fill a bag  Nuts & bolts games  Use clothes pins on rope  Build with magnets

13. 13 Fine Motor Activities to Improve School Functions (2) □ Manipulation skills  Place stickers on paper  Use eye dropper to squirt coloured water on paper  Place dried peas in small container with tweezers  Use small musical keyboard  Hold coins & place one at a time in slot

14. 14 Preparing Children for Writing (1) □ Posture  Adjust seat & table height, use slant boards □ Hand dominance  E.g. Practice cutting, lacing, stringing beads □ Use of appropriate force  E.g. Writing on sand paper, hiding small objects in PlayDoh (Jane Case- Smith, 2008)

15. 15 Preparing Children for Writing (2) □ Tripod grasp  E.g. Twisting on/off lids, use pencil grips □ Letter forms  E.g. Use colour code to identify top & bottom of each line, practice dot-to-dot pictures, fill in missing parts of letters. □ Spacing & alignment  E.g. Use popsicle stick between words, self correct, draw letters in small boxes.

16. 16 Activities for Visual Motor Integration □ String macaroni □ Use toy hammer & nails □ Draw with templates □ Use tweezers to pick up small objects □ Lacing objects □ Cut shapes □ Make a necklace

17. 17 Sensory Integration Therapy (1) □ Professional treatment techniques □ Provides carefully guided sensory stimulation  Vestibular  Visual  Tactile  Proprioceptive i.e. through muscles & joints. □ Purposeful activities requiring adaptive response

18. 18 Sensory Integration Therapy (2) □ Educate teachers, parents, and older children about sensory integration and to develop strategies to adapt to and compensate for dysfunction  Environmental modifications  Adaptations to daily routines  Changes in how people interact with the child (Wilbarger & Wilbarger, 2002)

19. 19 Social Skills Training □ Groups conducted by interdisciplinary team  Increase social awareness  Encourage peer relationships E.g. asking a friend to play, sportsmanship  Improve self regulatory behaviours E.g. anger management  Enhance Language expression Role playing Use of “wh” questions to teach conversational skills

20. 20 Life Skills Training □ Functional independence  Daily living tasks  Play & developing hobbies □ Prevocational Testing & training in adolescents

21. 21 Integration of Interventional S trategies  Student’s class room schedule  School routines  Curriculum  At home

22. 22 Where is Therapy Provided □ School as team member  In classroom  Resource room □ Private clinics □ Multidisciplinary centers □ Child guidance clinics □ Hospitals

23. 23 In Conclusion □ Therapy or treatment provided by an occupational therapist  Helps child's developmental & physical skills  Focuses on use of hands and fingers coordination of movement, self-help skills, such as dressing and eating, and sensory and perceptual-motor integration  Includes design and adaptation of materials, equipment, and environment.

24. 24 Thank You