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The basic definition for an occupational therapist (OT) is one who assists a multitude of different people in finding independence or “normalcy” in their everyday lives. Many of these patients have some sort of illness or disorder that inhibits normal living. These people can range from children who were born with a disability to the elderly who are going through a difficult time with the loss of agility or mobility. Occupational therapists help people regain skills or learn new ones that will make their everyday lives easier.

The types of services occupational therapists offer include evaluations with the client and family to determine what goals would like to be met, creating intervention and plan for helping the patient reach these goals, and ensure the goals are being worked towards and met long term. Occupational therapists not only assist their patients firsthand but also monitor them long-term to ensure that success is being met.

Types of Occupational Therapy

During and after your education and schooling in the field of occupational therapy you will probably find that there are many settings in which you can work. The area you will work is dependent upon what type of patient you would like to work with and what unique skills they will require with therapy.

Once you have obtained your degree in occupational therapy you will be able to pursue whichever specialization you wish. These specializations may include pediatric, hand therapy, adult rehabilitation, vision rehabilitation, assisted living care and much more.

New opportunities in work settings are opening up for occupational therapy every day.

Locations for Occupational Therapy

The location and area in which you practice occupational therapy really depends on what types of patients you are working with. Some therapists may work in one individual area or a number of them. These locations include schools, detention centers, clinics (public and independent), communities (city and rural), corporate areas and health centers. Some therapists may work entirely with other medical professionals at their locations.

Occupational Therapy for Children

Working as a pediatric occupational therapist is a rewarding job. There is an abundance of children who require the assistance of an occupational therapist to reach their true potential and independence in life. A child with a congenital disease, injury or illness that has caused life-altering effects may benefit from occupational therapy services. Other children who require occupational therapy might have been diagnosed with ADD or ADHD, PDD, Autism, Cerebral palsy, or anxiety disorders.

Occupational therapists help children acquire and maintain the skills required to engage in everyday life. Finding creative and meaningful activities is an essential key in assisting those children to participate in self-care, school, and social settings. Pediatric occupational therapists work closely with the child’s family, caregivers, and the educational team, in order to come up with the best therapy program and intervention strategies.

Occupational Therapy for Adult

The general population that is commonly seen by occupational therapists is adult of various ages. Adults who require occupational therapy may include those with disorders (developmental and psychological), illness or injuries, and finally, those who are going through a major life change or crisis.

Occupational therapists working with adults often help their clients become more independent and improve the way they function. Sometimes this requires the use of certain technology, assistive devices, or adjustments to the client’s environment. In some settings, such as rehab or hospitals, the occupational therapist role is to assist their client to relearn the basic skills that might have been lost due to illness or injury.

These skills may include, but are not limited to, eating, dressing, walking and mobility, communication, and the use of assisting devices. In other settings, such as mental health, occupational therapists may help their clients find strategies that will promote engagement in meaningful activities, which in turn improve the quality of their life.

The help that adults require is highly dependent on the individual person. There will be occasions in which “normalcy” won’t be possible for certain adults. In the event of this situation, it is important that occupational therapists help their client get to the highest level possible through the use of strategies that can be used within their limitations.

Occupational Therapy for the Elderly

Occupational therapy for elderly people is growing due to the baby boomer generation aging as well as technological advances allowing for longer lives. Many of the occupational therapists who specialize with the elderly are working with those who have age-related diseases and ailments or may have suffered from heart attacks and strokes.

Those who have suffered from a recent stroke or heart attack may have a difficult time adjusting to their now limited abilities and independence. In extreme cases, these people may have to essentially relearn daily life tasks from scratch. Other elderly people may be suffering from debilitating disorders and diseases such as arthritis. Learning to use assistive devices due to loss of agility and balance is another area that the elderly may need help with.

Fine motor skills are important to a child’s development. Not having these skills can interfere with school and home activities. It is important to understand the difference between fine motor skills and gross motor skills.

Fine motor skills are those skills that require smaller, more delicate movement; usually using the smaller motion with an emphasis on the coordination of those movements. Gross motor skills are those skills using the larger muscles in the body, those to run, jump and move about.

Concerns with a child’s fine motor skills can be treated by a therapist with a strong focus in the area of pediatric occupational therapy. A child with fine motor problems may become easily frustrated in school when having to copy things from the blackboard or in art class because he or she may have problems either writing neatly, staying within the lines when coloring or cutting out shapes.

A child’s motor planning and speed of movement can be greatly affected in cases of fine motor control development. Motor planning involves the visual detection of motion and errors in movements. For a child’s movement to be effective things must be timed adequately and fine motor skills require a certain amount of attention and concentration as well.

What is more important is the order in which certain movement is made to accomplish a task. Managing complex activity using smaller muscle groups may be compromised when dealing with fine motor skill problems. School-age children face more fine motor skill problems than most other age groups, making pediatric occupational therapy a very important step in the treatment of this problem.

Children with fine motor skill problems may present other behaviors as well. At times a child may have underlying issues that could be associated with fine motor skill problems. They may actually present problems with an articulation of words and sounds due to the fact that fine motor control has to do with tongue movement as well; being the tongue is a smaller muscle.

Fine motor control struggles can be due to sensory problems in the brain; the child may have an aversion to being touched and being introduced to new things. In these cases the child’s ability to behave and control their fine motor skills may be hampered by the overstimulation of the senses, causing frustration and clumsiness.

Children experiencing fine motor skill problems may present the following issues:

• Clumsy pencil grasp (pincer grasp activities)
• – Poor scissor skills (activities with scissors)
• – Not able to grasp and release things in a controlled manner
• – Cannot hold small objects or use tools such as pencils and scissors
• – Dislikes completing mazes and dot to dots due to being easily frustrated with them
• – Has problems copying from the blackboard in class

Below are a few activities you might find helpful to promote functional grasp patterns:

• Squirt bottles can be used to promote the pincer grasp (pincer grasp activity ideas)
• Bead stringing/lacing with the tip of the finger against thumb
• Practice screw and unscrew lids
• Activity ideas using bubble wrap to promote pincer grasp
• Play dough can be used to promote the pincer grasp.
• Tear pieces of construction paper into small pieces and paste the different colors of paper on a simple picture from a coloring book, or make your own design.
• Use tongs/tweezers to pick up blocks/small objects.
• Pennies into a piggy bank or slot cut in a plastic lid. Coins can also be put into slots cut in foam.
• Working on a vertical surface, especially above eye level. Activities can be mounted on a clipboard or tapes to surface or chalkboard/easel. Examples: pegboards, Lite Brite, Etch-a-sketch( upside down), Magna Doodle, outlining, coloring, painting, writing.
• Clothespins/pinching. Put letters on clothespins and spell words by clipping on edge of a shoe box. Use a clothespin to do finger “push-ups” by using the pads of the thumb and index finger to open a clothespin and count repetitions.

The Dynamic Tripod Grasp

Handwriting, is a more complex skill than we often realize. A child’s ability to color within the lines, trace over a shape and draw simple pictures forms the building blocks for writing letters and words.

Mastery of these pencil skills focuses on the content of their writing rather than the mechanics of pencil, speed, and movement. However, given society’s emphasis on, and haste to commence, ‘academics’ earlier, we sometimes overlook the vital role these seemingly basic skills play in developing writing skills. Yet we expect children to demonstrate their knowledge on paper in order to assess their pace.

Handwriting is influenced by the development of appropriate sensorimotor, perceptual and cognitive skills.

One of the most common problems occupational therapists in the school are consulted for is improper pencil grasp.

While the most efficient way to hold a pencil is the dynamic tripod grasp, many other patterns are commonly seen in children, and it does not always require intervention or modification. In the dynamic tripod grasp, the pencil is held between the thumb and index finger, with the pencil resting on the middle finger.

There are a variety of reasons why children hold their pencils in patterns other than the dynamic tripod. One common reason is participating in a lot of writing before their hands are developmentally ready for this activity. This is becoming more and more common as parents try to start preparing children to school with writing activities at an earlier stage.

It is important to try to modify the pencil grasp as early as possible since many students seem to have developed bad habits even before entering kindergarten.

Adaptive Pencil Grips

Adaptive pencil grips may be helpful in teaching students to modify their grasp and are used to facilitate an optimal pencil grasp.

There are many different types of grips available. For a pencil grip to be effective, the student needs to be involved in choosing the grip and to understand the importance of using it.

The most optimal position for writing includes the ankle, knee, and hip at right (90 degrees) angles with the forearms resting on the desk. The top of the desk should be approximately 2 inches above the elbows when the arms are at the student’s side.

Pencil Grasp Patterns

Functional Grasp Patterns

Tripod grasp with open web space: The pencil is held with the tip of the thumb and index finger and rests against the side of the third finger. The thumb and index finger form a circle.

Quadripod grasp with open web space: The pencil is held with the tip of the thumb, index finger, and third finger and rests against the side of the fourth finger. The thumb and index finger form a circle.

Adaptive tripod or D’Nealian grasp: The pencil is held between the index and third fingers with the tips of the thumb and index finger on the pencil. The pencil rests against the side of the third finger near its end.

Immature Grasp Patterns

Fisted grasp: The pencil is held in a fisted hand with the point of the pencil on the fifth finger side on the hand. This is typical of very young children.

Pronated grasp: The pencil is held diagonally within the hand with the tips of the thumb and index finger on the pencil. This is typical of children ages 2 to 3.

What is an efficient pencil grip?

“A pencil hold that provides speed, legibility is comfortable and will not cause harm to the joints of the hand over time. If a hold satisfies these criteria there is no need to change it” (Benrow 2002, cited: Foundation of Paediatric Practice for the Occupational Therapy Assistant, 2005)

Inefficient Grasp Patterns

Five finger grasp: The pencil is held with the tips of all five fingers. The movement when writing is primarily on the fifth finger side of the hand.

Thumb tuck grasp: The pencil is held in a tripod or Quadripod grasp but with the thumb tucked under the index finger.

Thumb wrap grasp: The pencil is held in a tripod or Quadripod grasp but with the thumb wrapped over the index finger.

Tripod grasp with closed web space: The pencil is held with the tip of the thumb and index finger and rests against the side of the third finger. The thumb is rotated toward the pencil, closing the web space.

Finger wrap or interdigital brace grasp: The index and third fingers wrap around the pencil. The thumb web space is completely closed.

Flexed wrist or hooked wrist: The pencil can be held in a variety of grasps with the wrist flexed or bent. This is more typically seen with left-hand writers but is also present in some right-hand writers.

Activities to Improve Pre-Writing Skills

The following list of activities can be used to improve pre-writing skills. Additional ideas and examples can be found here.

• Playing jump roping
• Volleyball-type of activities where hands, paddles, or rackets are in a palm-up position
• Squeezing squirt bottles (activities using squirt bottles)
• Shifting a slinky back and forth with the palm up
• Bead stringing/lacing with the tip of the finger against thumb
• Pouring from a small pitcher to a specific level in the clear glass. Increase the size of the pitcher as strength increases.
• Screwing and unscrewing lids
• Pop bubble wrap
• Playdough/silly putty activities
• Using a turkey baster or nasal aspirator to blow cork or ping pong balls back and forth (these can also be used to squirt water to move floating objects/toys).
• Tearing pieces of construction paper into small pieces and paste the different colors of paper on a simple picture from a coloring book, or make your own design
• Performing floor activities – large mural painting, floor puzzles, coloring when lying on the stomach on the floor
• Completing dot-dots, color by number, mazes
• Wheelbarrow walking child’s hands are the large ones from Bed Bugs game or kitchen tongs
• Playing string games with your hands such as Cat’s Cradle
• Using tongs/tweezers to pick up blocks/small objects
• Placing pennies into piggyback or slot cut in the plastic lid (coins can also be put into slots cut in foam)
• Working on a vertical surface, especially above eye level by mounting on a clipboard or tapes to surface or chalkboard/easel (examples: pegboards, Lite Brite, Etch-a-sketch, Magna Doodle, outlining, coloring, painting, writing)
• Clothespins/Pinching (put letters on clothespins and spell words by clipping on edge of a shoebox. Use a clothespin to do finger “push-ups” by using the pads of the thumb and index finger to open a clothespin and count repetitions)
• Moving objects around in the palm of your hand (pick up with index finger and thumb, move into palm without using the other hand)
• Squeezing sponges to wash off the table, clean windows, shower, etc.

(Last updated on April 16th, 2020)

Perspectives on sensory, texture, and environmental control factors: tips for picky eaters, feeding problems, and expanding your child’s diet.

Eating is a developmental process which changes over time as the child becomes more confident with his/her eating skills. Many children between the ages of two and three years old are picky eaters because they are going through a state of development where they fear new foods. This state may occur at a later stage in children with developmental delays. The fear of new foods generally improves during childhood. These changes in childhood are normal and most children balance their food selections and eat a nutritional diet over a period of time. Children with special needs sometimes are described as “picky eaters”, meaning they may have limited food selection, show anxiety or tantrums when presented with new foods, and/or require one or more foods be prepared in the same manner. Solving the feeding dilemma is not a quick fix.

Feeding Development: Texture Perspective

“Texture” refers to how smooth, lumpy, thick or thin the food is. This chart describes textures, examples of food, and the age the child generally is expected to handle a given texture:

0 – 13 months	breast/bottle
6 months	thin purees	stage 1 Baby Food
7 months	thick purees	stage 2 Baby Food
9 months	meltable hard solids	Graham crackers, Fruit Loops (foods which dissolve with spit only)
10 months	soft cubes	Gerber Graduates fruits, boiled potatoes, bananas
11 months	single textured soft mechanical	muffins, soft pasta, thin meats in small rectangles
12 months	mixed texture soft mechanical	macaroni and cheese, fries, spaghetti
16 months	hard mechanical	pretzel sticks, ritz crackers, chips

When working with your child with chewing and/or swallowing difficulties, there are a few general principles to keep in mind:

• Often times, a child with swallowing problems is able to handle thicker foods and liquids best (e.g. applesauce in apple juice, yogurt, etc).
• Chewable foods that maintain a solid mass are often easier to handle (e.g. banana, pancakes, etc).
• Food with more than one consistency are more difficult to handle (e.g. soup with veggies/meat).

Feeding Development: Sensory Perspective

Children developmentally learn to accept new foods through their senses such as smell, touch, and taste. Providing children with experiences to learn each new food from its’ sight, smell, and texture often increases their tolerance and acceptance. Here are some guidelines and ideas to promote your child’s sensory development in feeding:

• Activities for learning about new foods can be implemented either at the end of the meal or a separate scheduled time dedicated to “learning about new foods”
• Graded sensory input (such as background visual and auditory stimuli) to fit the child’s level of sensitivity
• Keep it fun without any coercion to explore a new food and maintain a positive and supportive attitude
• Activities to “touch” new foods
• Painting with food
• Stamping with food
• Stringing the food items onto yarn to make food jewelry
• Activities to “smell” new foods
• Placing a food item in the container and have your child smell it through the hole on the top then guess the item
• Activities to “taste” new foods
• Tasting a new food item begins with licking the item, then holding a small bite on the tongue, and finally chewing a small portion
• Allow your child to spit out a new food item during the beginning of the exploration or have ice or water on hand for your child to use
• Have your child to make a “teeth mark” on a food item
• Invite your child to join the cooking process

Environmental Control Perspective for Picky Eaters

Environmental factors play a key role in developing and maintaining food aversions and problem eating. Environmental controls include scheduling meals, selecting an appropriate setting, creating a supportive climate, designing meals and portion sized, and addressing food jags.

Guidelines for creating the meal/snack schedule to help with consistency and predictable routines:

• Write a schedule that is understandable and clear to the child
• Use a timer to indicate when the next meal/snack will begin
• Use a kitchen timer during the meal to set the pace and length of the meal
• Make sure the mealtime schedule includes snacks
• Offer the child at least one preferred food item at every meal and/or snack
• Provide only water to the child between the scheduled meal/snack time to limit grazing

Mealtime setting should be a comfortable and supportive setting to help your child relax and focus on learning new skills to eat:

• Eating and drinking should be done at the table for proper stability and posture
• The child should sit in a chair with feet resting on the floor
• The number of distractions at mealtimes should be kept to a minimum
• Parents, siblings, and peers play an important role during the meal for socialization

Guidelines for creating a supportive mealtime environment for a child to feel supported, safe, nurtured, and trusted to explore new foods/skills:

• Respect the child and do not invade his/her mouth without permission
• Role–play and demonstrate eating techniques
• Never discuss the child’s eating habits or how much he/she eats during the meal
• Discuss the taste, texture, and smell of new foods

Portion size and food selection should be presented in a manner that allows a child to be successful.

• Provide your child with an age-appropriate sized plate and utensils
• It is better to start the meal with smaller portion sizes as it allows the child to see the results when taking a few small bites
• A good rule of thumb for controlling portion size is to consider one tablespoon of each type of food for each year of the child’s age

Food selection should take into consideration the child’s age and eating habits. Keep in mind that new and exotic foods can be scary for your child.

• Select only one menu for the entire family and include a variety of foods familiar to the picky eater as well as some new foods
• Select foods that are child-friendly
• Consider texture, color, and smell when introducing a new food
• Include a piece of bread or roll with meals since child is often successful with this
• Be flexible since the goal is for long-term changes it is ok to miss one balanced meal or not to always have the family eat the exact same meal

Food Jags refers to the insistence on the same food, serving utensils, or even the same setting over long periods of time. Guidelines for addressing food jags:

• Create opportunities for structured flexibility and choice making allowing the child to have some choices (foods, dining ware etc) while maintaining the structure of the schedule and healthy choices
• Do not cater to the child’s rigidity in wanting only the same foods. Make slight changes in the presentation such as changing the noodle shape for insistent mac-n-cheese eaters
• Include the child in food preparation and presentation

Guidelines for implementing appropriate mealtime behaviors:

• Resistant eaters often exhibit challenging behaviors during mealtimes due to their persistent food aversions. Be patient and take the time to extinguish challenging behaviors and replace with appropriate behaviors
• Set up a routine for transitioning to the table
• If the child exhibits noncompliance or tantrums during the meal, calmly remove them to a safe area away from the group
• If the child throws food or destroys food, he must clean it up
• Analyze your judgment about the child’s behavior in terms of cultural beliefs, messiness, and expectations