Occupational Therapists:

Who Are They &
What Do They Do?

OTs assist individuals of all ages, infants to adults who are having difficulty performing daily tasks and functions. For instance, an adult who has suffered a brain injury might see an occupational therapist for help recovering lost skills. A young child with a disability might, for example, see an occupational therapist for help learning how to feed herself.

Children with fragile X syndrome are often referred to an occupational therapist since many (although not all) exhibit delays in fine and gross motor development, difficulties with sensory processing, hyperactivity, and attention deficits. Many children with FXS have low muscle tone and loose connective tissue. This may make it more difficult for them to learn skills such as feeding, dressing, coloring, writing, running, and jumping. A child who has sensory processing impairments may be overly sensitive or under-reactive to touch, movement, sights, smells, pain, or sound. His or her nervous system is unable to receive and respond correctly to incoming sensory information and this individual may "shutdown," withdraw, become irritable or seek out intense sensory experiences by mouthing toys, spinning, banging, etc. An individual may fluctuate from one type of response to the other. Other indicators of sensory processing difficulties include coordination problems, delays in speech/language, poor behavioral organization, and poor self-concept.

Generally, occupational therapists target self-care, play, and educational activities when working with children. They may work in early intervention agencies, developmental testing centers, schools, group homes, and many other settings. Children who receive occupational therapy services usually average one or two treatment sessions per week, for anywhere from 30 to 90 minutes. School-based occupational therapy sessions may occur in the classroom in an "integrated setting," while the child is participating in the classroom routine, or in "pull-out" sessions, when the child leaves the classroom for therapy. After assessing a child’s current skills and needs, an occupational therapist develops an intervention program using a variety of strategies such as making changes/adaptations in the child’s physical environment or routine, and improving skills or coordination through activities designed to enhance certain components of the skill. For example, if the goal is to improve a child’s handwriting skills, intervention may include pencil positioning, letter formation, and posture during writing. Suggestions for hand and finger strengthening activities may be left with the parent and teacher.

Typically, occupational therapists suggest environmental changes to help improve sensory processing. Calming suggestions for over-sensitivity may include the following:

• Avoiding use of fluorescent light; using "natural light" when available
  
• Playing quiet, soft music (classical, baroque)
  
• Being aware of strong odors and avoiding them
  
• Using slow, rhythmic rocking
  
• Applying vibration—vibrating pillows, oscillating boards, washing machine, car ride
  
• Providing small, cozy spaces—sleeping bags, barrels with cushions, boxes with pillows
  
• Applying deep pressure such as big hugs, weighted vests, allowing child to lie under heavy mats, pillows or bean bags
  
• Providing tactile experiences by wrapping with flannel, lambswool, and cotton; rhythmic stroking on back or extremities
  
• Encouraging deep pressure in the oral area by chewing or drinking thick liquids through a straw
  
• Using ear muffs or head phones to decrease distraction and auditory stimulation
  

Strategies for alerting and arousing under-reactive sensory processing may include:

• Providing bright lighting, spicy odors (cinnamon, cloves)
  
• Using arrhythmic, irregular, quick movements
  
• Giving light or irregular touch, such as stroking against the hair
  
• Bouncing child on therapy ball
  
• Encouraging cold water play or eating cold foods
  
• Providing opportunities for rolling downhill/incline, somersaults
  
• Encouraging gross motor activities such as jumping jacks, turning in a circle, jumping up and down