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When should a child be referred to an occupational therapist?

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Following is a few easy questions that could help you to determine if a child should be referred to an O.T.

 What is fine eye-hand coordination?

This is the ability to use eyes and hands together to perform a task.  We all use this skill every day in all different kinds of situation:  tying shoe-laces, writing, cutting, dressing, the list is endless.

How will I know if a child has a problem?

  • Drawing shows poor orientation on the page and the child is unable to stay within the lines when colouring/writing.
  • Your child will struggle with activities that kids the same age finds easy e.g. buttoning small buttons when dressing, picking up small objects
  • Your child will rather get involved in gross motor activities e.g. swinging than doing colouring, pegboard tasks, etc.
  • Threading activities will be difficult or avoided
  • Child will find it difficult to cut neatly on a line
  • Handwriting won’t be neat.

Muscle tone 

Muscle tone refers to the natural stress in the muscle when at rest. It is not the same as muscle strength. A child with a natural lower tone in his muscle will use his muscles with more effort than a child with a natural higher muscle tone.

How will I know if a child has a problem?

  • Tires easily / or moves around the whole time to maintain muscle tone
  • Appear clumsy / uncoordinated
  • Child will over emphasize movement / use exaggerated movement patterns
  • Lean on to objects
  • Find it difficult to maintain one position for a long time
  • Slouch in chair
  • Use broad base of support when sitting
  • Drool
  • Fidgety – uses this to build up tone when sitting for long periods of time
  • Usually doesn’t part-take in endurance sport

What are visual perceptual skills?

These skills are necessary to interpret seen information in the brain.

These skills are the building blocks for reading, writing and maths.

How will I know if a child has a problem?

  • Kids who struggle with foreground-background will ‘steals’ words/letters from other sentences/words and add it to the word/sentence they are busy reading.  They also find it difficult to find specific words/numbers on a page.
  • Kids with a limitation in position in space and/or spatial-relationships will confuse p/b/d, switching of words in a sentence or switching of syllables.
  • Kids with a limitation in form-constancy will struggle to read different types of fonts/hand writing and to copy writing from the black board.
  • Kids with closure impairment will confuse letters with each another when different fonts of writing are used e.g. a/d; u/a; c/e.
  • Kids with impairment in discrimination will for example struggle to find words/numbers that is the same.
  • Kids that struggle with analysis and synthesis finds it difficult to read words that they have to spell
  • Kids with a limitation in memory will for example struggle to copy work from the black board
  • Kids that struggle with consecutive memory will for example find it problematic to copy words/sentences/numbers correctly from the black board.

What is bilateral integration?

That is the ability of both sides of the body to work together to perform a task.

How will I know if a child has a problem?

  • Appears to be uncoordinated when doing tasks
  • Difficulty in performing gross motor tasks e.g. skipping, galloping, jumping-jacks, etc.
  • Prefers not to cross the imaginary midline of the body
  • Not choosing a dominant hand to write/draw/colour (after age 5)
  • Swapping hands when doing tasks

What is dyspraxia?

Praxis (a.k.a motor planning) is the ability of the brain to conceive, organize, and carry out a sequence of tasks/actions.

Praxis is the ability to self-organize.

Praxis includes motor planning, cognitive events and communication.

The child may present with the following:

  • Appear clumsy
  • Poor balance
  • Difficulty with riding a bike
  • Poor handwriting
  • Difficulty with remembering instructions and copying from the blackboard
  • May have difficulty with speech and the ability to express themselves
  • Bumping into objects
  • Late establishment of laterality (right- or left-handedness)
  • Poor sense of direction
  • Difficulty in learning new motor skills (crawling, using utensils and tools, catching a ball, penmanship)
  • Difficulty in completing tasks with multiple steps (playing board games, sports,  solving puzzles and learning math skills)
  • Difficulty in doing tasks in the proper sequence (dressing, or following directions with multiple steps, putting together words and sentences in the right order)
  • Difficulty copying designs, imitating sounds, whistling, imitating movements
  • Difficulty in adjusting to new situations or new routines
  • Difficulty in judging distance in activities (riding bicycles, placing objects) or with others (standing too close or too far away)
  • Present with delayed skills – remaining in the early stages of skill acquisition
  • Poor at holding a pencil
  • Forgetful and disorganized
  • Have a poor attention span
  • Need to go right back and begin again at the very beginning of the task when experiencing difficulty, instead of just ‘getting on with it’
  • Have difficulty using tools – cutlery, scissors, pencils – lots of handwriting problems (although not all handwriting difficulties are the result of motor Dyspraxia) poor balance;
  • Have poor fine and gross motor co-ordination
  • Have poor awareness of body position in space
  • Have difficulty with reading, writing, speech and maths

Other signs/symptoms

  • Child acts immature (cries easily, separation anxiety, etc.).
  • Concentration difficulties / easily distracted by things/people/sounds around himself/herself.
  • If a child is struggling with reading, writing, spelling, maths.
  • If a child’s school progress is behind the other kids in the class.
  • If a child has a physical impairment that is influencing his/her playing, walking, running, etc.
  • Hurts himself or other children / appear to be aggressive  –  when children struggle with certain developmental skills they may become angry easily because of frustration.  Kids who have poor self-control/impulsivity often cannot control themselves physically when angry.
  • Hyperactive child / child who fidgets / cannot sit still / talks non-stop – this child may have ADD or ADHD
  • Children who turn the paper when drawing/colouring/writing – this may be because the child is avoiding to cross the imaginary midline of the body

A complete occupational therapy assessment will be done to determine any limitations.

If therapy is recommended it is usually for once a week for 6 – 12 months, according to the progress of each child.

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