Occupational Therapy

Murray Therapy 1914 N. Steele Tacoma, WA 98406 MurraryTherapy@worldnet.att.net

Michelle and John C. Murray are Pediatric Occupational Therapists in private practice in Tacoma, WA. Your questions and comments are welcome.

As Pediatric Occupational Therapists we view our role as facilitators who promote independence in a child’s life. We attempt to provide this independence in the areas of self-care, mobility, and play. The exciting appeal of working with children and families who are experiencing challenge, is the active problem solving that takes place between parent, child and therapist. Each person brings a unique perspective, which leads to a clearer picture of the child’s strengths and needs. As a team we create a plan that addresses the child’s and family’s current needs as well as looking toward more long term goals.

We have chosen five general areas to discuss which we hope will be relevant to

many of the readers for NATHHAN NEWS. These areas include:

Self-feeding

Dressing skills

Mobility and

Computer use

Although each topic could be an article in itself, we hope to cover some basics.

Feeding is often a challenge for children as well as their parents. As with any new learning, the key to feeding is in the problem solving and trouble shooting process. The first step is to determine the cause of the difficulties.

1. Is the child motivated to eat? Developmentally, there are times when children love to eat (newborns) and other times when they would rather not take precious time away from playing (beginning about age 2 through life).

2. Does the child have sensitives to the food texture? If so, it would be good to consider this when preparing the food. Many children can tolerate smooth pureed foods before they will accept a chunkier texture. Often the most difficult to handle are mixed textures such as soup with noodles or vegetable.

3. Does the child have motor limitations that interfere with his independence? This is where a variety of adaptive aids may be beneficial from a nonskid material (Dycem) placed under the bowl, a cup with handles. There are many products such as scoop dishes, adapted utensils, and sippy cups available through specialty adaptive equipment catalogs. However we have found a variety of off the shelf store products that also work wonderfully at about half the cost.

4. Finally, is the child in a food position for feeding? This is imperative. Being properly positioned for an activity is better than half the challenge. Head up, shoulders and arms directed forward, trunk well supported and feet resting on a supportive surface can often make movements with the hands and mouth much easier. For young children with poor trunk control this positioning can be achieved with a foam insert made for their high chair.

Dressing, like eating, is a skill that life requires us to accomplish at least a couple times a day. It is good to start early with this skill by talking to your child as you dress them - "put your arm in", "over your head", "foot in." Children listen and learn much earlier than they are able to speak. Later, some with motor planning problems may use this skill of talking themselves through the dressing process to tell their muscles how to move so they can get their sweater on. Dressing is a repetitive process. Therefore, the more opportunities a child has to practice, the greater his chances for success. Often a successful approach is to utilize a backward chaining method in which a parent performs the majority of the task and the child completes the final step. The parent gradually decreases the number of steps she performs, thus increasing the child’s independence.

Mobility. As occupational therapists, we tend to leave the more traditional mobility skills (walking, transferring, etc.) to the physical therapists. However, we have a strong interest in promoting independent mobility by whatever means possible. One of our favorite methods is to get children on tricycles. A regular tricycle, purchased at a garage sale and adapted with foot pedals can be an inexpensive way to give a child some independence. On the more expensive end of the spectrum is powered mobility. We have worked with several children who have been quite successful operating a power wheelchair with either a modified joystick or several switches.

Computers. We attended a technology conference a few years ago and were able to talk with many adults with special needs. A common theme we heard is how the use of computers has opened up many new opportunities for them. Our feeling is that for children with special needs, a computer can be a great equalizer. We believe computers help to foster many pre-academic skills such as cause and effect and problem solving. Computers can also function as a communication system for children who are unable to talk. We also think a computer is a valuable tool for children who have much difficulty with written work. Often, they are able to get their thoughts down on paper via a keyboard more easily than with a pencil and paper. When assessing a child’s ability to utilize a computer, one of the first areas we address is the input method. Many children have greater success with a Touch Window or a switch rather than the traditional keyboard or mouse. They next most important factor is the software. We recommend programs, which maximize interaction. Some of our favorites include the Edmark House Series and the Living Book Series. Edmark’s phone number is: 1-800-362-2890. We have found this excerpt form Guide My Feet: Meditations and Prayers on Loving and Working for Children to be an inspiration for us.

Dear God,

I thank you for the gift of this child to raise, this life to share, this mind to help mold, this body to nurture, and this spirit to enrich.

Let me never betray this child’s trust, dampen this child’s hope, or discourage this child’s dreams. Help me dear God to help this precious child become all you