OTNOW • MAY/JUNE 2002 • © CAOT PUBLICATIONS ACE
Occupational Therapy: Skills for the Job of Living
The evidence supports the effectiveness of occupational
therapy in the school setting on goal attainment and
skill development in areas underlying and supporting
school performance. Reframing the views and expectations
of the student by the adults in the environment is another
positive outcome. Collaborative consultation with parents
and teachers appears to be an essential component in maximizing
effectiveness of service delivery and satisfaction.
These findings come from studies of school-based occupational
therapy with students with a variety of underlying
problems, including physical disabilities, developmental
coordination disorder, fine motor difficulties, developmental
delays and learning disabilities.
School performance in the areas of reading,writing,mathematics,
manipulation of tools, performance in physical
education, independence with self-care tasks and social
integration are dependent on gross motor and fine motor
abilities, visual-motor integration, and visual-perceptual
skills.
Palisano (1989) concluded that six- to nine-year-old
children with learning disabilities improved in their
gross motor and fine motor abilities, visual-motor integration
and visual-perceptual skills with occupational therapy intervention.
How occupational therapy makes a difference in the school system: A summary of the literature
WHAT IS OCCUPATIONAL THERAPY?
Occupational therapy is a health care profession concerned
with a person’s ability to perform daily
occupations, including self-care, productive and
leisure activities.
Occupational therapists are trained to assess and treat
occupational performance problems in the environments
where these occupations are being done.
Occupational performance is a determinant of health,
well-being and helps give meaning to life.
GOAL OF OCCUPATIONAL THERAPY IN THE SCHOOL SYSTEM:
Maximizing the occupational performance of the student with special needs
A child’s occupational performance may be impaired
by physical, developmental, sensory, attentional and/or
learning challenges. The goal of occupational therapy is
to improve the student’s performance of tasks and
activities important for successful school functioning.
The occupational therapist is concerned with ensuring
an understanding of, and match between the student’s
skills and abilities and the expectations placed on
him/her in the school setting.
Recommendations of task adaptations, task modifications
and assistive devices (e.g. mechanical lift,
writing aid) may be necessary to optimize the child’s
performance in the school setting. Direct intervention
to improve, restore, maintain or prevent deterioration
in the skills required for functioning in the school environment
is often necessary; for example, therapy to
develop the motor coordination, visual-motor coordination
and/or visual perceptual skills supporting
school performance. Greater interaction between the teacher and the therapist
leads to enhanced effectiveness of occupational therapy.
Dunn (1990) found that both direct occupational therapy
intervention and collaborative consultation between
the occupational therapist and teacher were effective in
assisting students with developmental challenges attain
their goals as identified on their Individualized
Education Plan. Teachers saw collaborative consultation
as impacting more on the occupational therapy contribution
to goal attainment than direct intervention alone.
Occupational therapy intervention, together with high
levels of collaboration with teachers, resulted in
improved handwriting legibility in a group of students
with poor handwriting legibility (Case-Smith, 2002).
Occupational therapists enable a more positive view of the
student and provide a basis for developing new and more
effective teaching and/or parenting strategies.
Niehues et al. (1991) discovered that occupational therapists
play a role in reframing the views of parents and
teachers concerning the discrepancies between student
performance and the expectations held for them.
The rate of change in school productivity for children
receiving occupational therapy exceeds that expected due
to maturation.
King et al. (1999) reported that direct therapy, monitoring
and collaborative consultation between therapists,
teachers and parents resulted in clinically significant
gains in school productivity goals. Educationally relevant
productivity goals included copying from the board, correctly
holding a pencil, keyboarding, cutting, colouring,
use of a computer mouse, organizing a desk and focusing
on a task.
Occupational therapy programs enhancethe student’sability
to learn, and occupational therapists eliminate problems
that interfere with a child’s ability to profit from
instruction.Occupational therapists provide medical,physical
and developmental information in educationally relevant terms.
Fairbairn and Davidson (1993) found that southern
Ontario teachers value the work of occupational therapists
in the schools.
Developmental Coordination Disorder (DCD)
DCD affects six per cent of the population. Children with
DCD lack the motor coordination to perform daily self-care
and productive and/or leisure tasks. They experience frequent
failure and lower self-confidence,which affects social,
academic and physical performance. DCD commonly coexists
with learning disabilities and/or attention deficit disorder
(from findings of a literature review by Fox & Lent,1996).
There is early promising evidence that “top-down”
approaches used by occupational therapists are effective
in improving the functional performance of children
with DCD (Polatajko et al., 2001).
One such approach, the Cognitive Orientation to Daily
Occupational Performance (CO-OP), is effective in skill
acquisition and there is emerging evidence that CO-OP
also results in generalization and transfer of skills
(Polatajko et al., 2001).
Early identification and intervention may have a positive
impact on the life of a child with DCD.Occupational therapists
can quantify the disability,advocate for modifications
including changed expectations,assist in providing
information to parents,teachers and children and offer
intervention techniques related to schoolwork,leisure and
activities of daily living.
Written productivity
Children with delays in writing readiness benefit from
early intervention by occupational therapy.
Oliver (1990) found that five and six year olds with a gap
between performance and verbal intelligence improved
their writing readiness by 17 months over a school year
with weekly occupational therapy intervention and regular
client practice.
Teachers reported that intervention had a positive effect
on self-confidence in written output,and on the maturity
of written expression (Lockhart & Law,1994).
• Lockhart and Law (1994) determined that nine- to 11-
year-old students with a learning disability and sensorimotor
difficulties improved cursive writing skills following
participation in a multisensory occupational therapy
writing program.
• Case-Smith (2002) concluded that seven- to 10-year-old
students with poor handwriting legibility showed significant
increases in in-hand manipulation, position in
space and handwriting legibility following about 16 sessions
of occupational therapy, when compared with students
who did not receive services.
How children with specific conditions benefit from occupational therapy
THERE IS EVIDENCE TO SUPPORT THE EFFECTIVENESS OF OCCUPATIONAL THERAPY IN THE SCHOOL ENVIRONMENT.
Students with a variety of special
needs benefit from the intervention of an occupational
therapist to assist them with performance in school.
COLLABORATIVE CONSULTATION between the occupational
therapist and teacher appears to be CRITICAL
to the effectiveness of the intervention.
EARLY INTERVENTION IS IMPORTANT to minimize the
secondary behavioural, emotional, physical and
psychiatric problems that can result from students
experiencing challenges with their daily
occupations.
OCCUPATIONAL THERAPY intervention in the school
environment assists in REDUCING FUTURE COSTS
TO THE HEALTH CARE AND SOCIAL SERVICE SYSTEMS.
References
Case-Smith, J. (2002). Effectiveness of school-based occupational
therapy intervention on handwriting. The
American Journal of Occupational Therapy, 56, 17-25.
Dunn, W. (1990). A Comparison of service provision models
in school based occupational therapy services. A pilot
study. The Occupational Therapy Journal of Research,
10, 300-320.
Fairbairn, M. L. & Davidson, I. F. W. K. (1993). Teachers’ perceptions
of the role and effectiveness of occupational
therapists in schools. Canadian Journal of Occupational
Therapy, 60, 185-191.
Fox, A. M. & Lent, M. A. (1996). Clumsy children. Primer on
developmental coordination disorder. Canadian
Family Physician, 42, 1965-1971.
King, G., McDougall, J., Tucker, M. A., Gritzan, J., Malloy-
Miller, T., Alambets, P., Cunning, D., Thomas, K., &
Gregory, K. (1999). An evaluation of functional,
school-based therapy services for children with special
needs. Physical and Occupational Therapy in Pediatrics, 19, 5-29.
Lockhart, J., & Law, M. (1994). The effectiveness of a multisensory
writing program for improving cursive writing
ability in children with sensorimotor difficulties.
Canadian Journal of Occupational Therapy, 61, 206-214.
Niehues, A. N., Bundy, A. C., Mattingly, C. F., & Lawlor, M. C.
(1991). Making a difference: Occupational therapy in
the public schools. The Occupational Therapy Journal of
Research, 11, 195-212.
Oliver, C. E. (1990). A sensorimotor program for improving
writing readiness skills in elementary-age children. The
American Journal of Occupational Therapy, 44, 111-116.
Palisano, R. J. (1989). Comparison of two methods of service
delivery for students with learning disabilities. Physical
and Occupational Therapy in Pediatrics, 9, 79-100.
Polatajko, H. J., Mandich, A. D., Miller, L. T. & Macnab, J. J.
(2001). Cognitive orientation to daily occupational
performance (CO-OP): Part II- The evidence. Physical
and Occupational Therapy in Pediatrics, 20, 83-106.
Additional readings in the original literature search
Dewey, D. & Wilson, B. N. (2001). Developmental coordination
disorder: What is it? Physical and Occupational
Therapy in Pediatrics, 20, 5-27.
Law, M., Steinwender, S., & Leclair, L. (1998). Occupation,
health and well-being. Canadian Journal of
Occupational Therapy, 65, 81-91.
Missuina, C. (1999). Keeping current in… Children with fine
motor difficulties. CanChild Centre for Childhood
Disability Research, KC #99-3.
Missuina, C. (1996). Keeping current in… Developmental coordination
disorder. Neurodevelopmental Clinical
Research Unit, KC #96-3.
This information was compiled and written by Sandra
Sahagian Whalen, a paediatric occupational therapist
who works with Community Rehab as the Professional
Practice Leader for Paediatric Occupational Therapy in
the Peel Region, Ontario. Sandra acknowledges the
support of Nancy Pollock and Mary Law of the
CanChild Centre for Disability Research in Hamilton,
Ontario.
This information appeared in the May/June, 2002 issue
of Occupational Therapy Now magazine published by the
Canadian Association of Occupational Therapists.
For further information regarding the full literature
report, visit the CanChild web site, click on Keeping
Current at www-fhs.mcmaster.ca/canchild.
Occupational Therapy: Skills for the Job of Living
The evidence supports the effectiveness of occupational
therapy in the school setting on goal attainment and
skill development in areas underlying and supporting
school performance. Reframing the views and expectations
of the student by the adults in the environment is another
positive outcome. Collaborative consultation with parents
and teachers appears to be an essential component in maximizing
effectiveness of service delivery and satisfaction.
These findings come from studies of school-based occupational
therapy with students with a variety of underlying
problems, including physical disabilities, developmental
coordination disorder, fine motor difficulties, developmental
delays and learning disabilities.
School performance in the areas of reading,writing,mathematics,
manipulation of tools, performance in physical
education, independence with self-care tasks and social
integration are dependent on gross motor and fine motor
abilities, visual-motor integration, and visual-perceptual
skills.
Palisano (1989) concluded that six- to nine-year-old
children with learning disabilities improved in their
gross motor and fine motor abilities, visual-motor integration
and visual-perceptual skills with occupational therapy intervention.
How occupational therapy makes a difference in the school system: A summary of the literature
WHAT IS OCCUPATIONAL THERAPY?
Occupational therapy is a health care profession concerned
with a person’s ability to perform daily
occupations, including self-care, productive and
leisure activities.
Occupational therapists are trained to assess and treat
occupational performance problems in the environments
where these occupations are being done.
Occupational performance is a determinant of health,
well-being and helps give meaning to life.
GOAL OF OCCUPATIONAL THERAPY IN THE SCHOOL SYSTEM:
Maximizing the occupational performance of the student with special needs
A child’s occupational performance may be impaired
by physical, developmental, sensory, attentional and/or
learning challenges. The goal of occupational therapy is
to improve the student’s performance of tasks and
activities important for successful school functioning.
The occupational therapist is concerned with ensuring
an understanding of, and match between the student’s
skills and abilities and the expectations placed on
him/her in the school setting.
Recommendations of task adaptations, task modifications
and assistive devices (e.g. mechanical lift,
writing aid) may be necessary to optimize the child’s
performance in the school setting. Direct intervention
to improve, restore, maintain or prevent deterioration
in the skills required for functioning in the school environment
is often necessary; for example, therapy to
develop the motor coordination, visual-motor coordination
and/or visual perceptual skills supporting
school performance. Greater interaction between the teacher and the therapist
leads to enhanced effectiveness of occupational therapy.
Dunn (1990) found that both direct occupational therapy
intervention and collaborative consultation between
the occupational therapist and teacher were effective in
assisting students with developmental challenges attain
their goals as identified on their Individualized
Education Plan. Teachers saw collaborative consultation
as impacting more on the occupational therapy contribution
to goal attainment than direct intervention alone.
Occupational therapy intervention, together with high
levels of collaboration with teachers, resulted in
improved handwriting legibility in a group of students
with poor handwriting legibility (Case-Smith, 2002).
Occupational therapists enable a more positive view of the
student and provide a basis for developing new and more
effective teaching and/or parenting strategies.
Niehues et al. (1991) discovered that occupational therapists
play a role in reframing the views of parents and
teachers concerning the discrepancies between student
performance and the expectations held for them.
The rate of change in school productivity for children
receiving occupational therapy exceeds that expected due
to maturation.
King et al. (1999) reported that direct therapy, monitoring
and collaborative consultation between therapists,
teachers and parents resulted in clinically significant
gains in school productivity goals. Educationally relevant
productivity goals included copying from the board, correctly
holding a pencil, keyboarding, cutting, colouring,
use of a computer mouse, organizing a desk and focusing
on a task.
Occupational therapy programs enhancethe student’sability
to learn, and occupational therapists eliminate problems
that interfere with a child’s ability to profit from
instruction.Occupational therapists provide medical,physical
and developmental information in educationally relevant terms.
Fairbairn and Davidson (1993) found that southern
Ontario teachers value the work of occupational therapists
in the schools.
Developmental Coordination Disorder (DCD)
DCD affects six per cent of the population. Children with
DCD lack the motor coordination to perform daily self-care
and productive and/or leisure tasks. They experience frequent
failure and lower self-confidence,which affects social,
academic and physical performance. DCD commonly coexists
with learning disabilities and/or attention deficit disorder
(from findings of a literature review by Fox & Lent,1996).
There is early promising evidence that “top-down”
approaches used by occupational therapists are effective
in improving the functional performance of children
with DCD (Polatajko et al., 2001).
One such approach, the Cognitive Orientation to Daily
Occupational Performance (CO-OP), is effective in skill
acquisition and there is emerging evidence that CO-OP
also results in generalization and transfer of skills
(Polatajko et al., 2001).
Early identification and intervention may have a positive
impact on the life of a child with DCD.Occupational therapists
can quantify the disability,advocate for modifications
including changed expectations,assist in providing
information to parents,teachers and children and offer
intervention techniques related to schoolwork,leisure and
activities of daily living.
Written productivity
Children with delays in writing readiness benefit from
early intervention by occupational therapy.
Oliver (1990) found that five and six year olds with a gap
between performance and verbal intelligence improved
their writing readiness by 17 months over a school year
with weekly occupational therapy intervention and regular
client practice.
Teachers reported that intervention had a positive effect
on self-confidence in written output,and on the maturity
of written expression (Lockhart & Law,1994).
• Lockhart and Law (1994) determined that nine- to 11-
year-old students with a learning disability and sensorimotor
difficulties improved cursive writing skills following
participation in a multisensory occupational therapy
writing program.
• Case-Smith (2002) concluded that seven- to 10-year-old
students with poor handwriting legibility showed significant
increases in in-hand manipulation, position in
space and handwriting legibility following about 16 sessions
of occupational therapy, when compared with students
who did not receive services.
How children with specific conditions benefit from occupational therapy
THERE IS EVIDENCE TO SUPPORT THE EFFECTIVENESS OF OCCUPATIONAL THERAPY IN THE SCHOOL ENVIRONMENT.
Students with a variety of special
needs benefit from the intervention of an occupational
therapist to assist them with performance in school.
COLLABORATIVE CONSULTATION between the occupational
therapist and teacher appears to be CRITICAL
to the effectiveness of the intervention.
EARLY INTERVENTION IS IMPORTANT to minimize the
secondary behavioural, emotional, physical and
psychiatric problems that can result from students
experiencing challenges with their daily
occupations.
OCCUPATIONAL THERAPY intervention in the school
environment assists in REDUCING FUTURE COSTS
TO THE HEALTH CARE AND SOCIAL SERVICE SYSTEMS.
References
Case-Smith, J. (2002). Effectiveness of school-based occupational
therapy intervention on handwriting. The
American Journal of Occupational Therapy, 56, 17-25.
Dunn, W. (1990). A Comparison of service provision models
in school based occupational therapy services. A pilot
study. The Occupational Therapy Journal of Research,
10, 300-320.
Fairbairn, M. L. & Davidson, I. F. W. K. (1993). Teachers’ perceptions
of the role and effectiveness of occupational
therapists in schools. Canadian Journal of Occupational
Therapy, 60, 185-191.
Fox, A. M. & Lent, M. A. (1996). Clumsy children. Primer on
developmental coordination disorder. Canadian
Family Physician, 42, 1965-1971.
King, G., McDougall, J., Tucker, M. A., Gritzan, J., Malloy-
Miller, T., Alambets, P., Cunning, D., Thomas, K., &
Gregory, K. (1999). An evaluation of functional,
school-based therapy services for children with special
needs. Physical and Occupational Therapy in Pediatrics, 19, 5-29.
Lockhart, J., & Law, M. (1994). The effectiveness of a multisensory
writing program for improving cursive writing
ability in children with sensorimotor difficulties.
Canadian Journal of Occupational Therapy, 61, 206-214.
Niehues, A. N., Bundy, A. C., Mattingly, C. F., & Lawlor, M. C.
(1991). Making a difference: Occupational therapy in
the public schools. The Occupational Therapy Journal of
Research, 11, 195-212.
Oliver, C. E. (1990). A sensorimotor program for improving
writing readiness skills in elementary-age children. The
American Journal of Occupational Therapy, 44, 111-116.
Palisano, R. J. (1989). Comparison of two methods of service
delivery for students with learning disabilities. Physical
and Occupational Therapy in Pediatrics, 9, 79-100.
Polatajko, H. J., Mandich, A. D., Miller, L. T. & Macnab, J. J.
(2001). Cognitive orientation to daily occupational
performance (CO-OP): Part II- The evidence. Physical
and Occupational Therapy in Pediatrics, 20, 83-106.
Additional readings in the original literature search
Dewey, D. & Wilson, B. N. (2001). Developmental coordination
disorder: What is it? Physical and Occupational
Therapy in Pediatrics, 20, 5-27.
Law, M., Steinwender, S., & Leclair, L. (1998). Occupation,
health and well-being. Canadian Journal of
Occupational Therapy, 65, 81-91.
Missuina, C. (1999). Keeping current in… Children with fine
motor difficulties. CanChild Centre for Childhood
Disability Research, KC #99-3.
Missuina, C. (1996). Keeping current in… Developmental coordination
disorder. Neurodevelopmental Clinical
Research Unit, KC #96-3.
This information was compiled and written by Sandra
Sahagian Whalen, a paediatric occupational therapist
who works with Community Rehab as the Professional
Practice Leader for Paediatric Occupational Therapy in
the Peel Region, Ontario. Sandra acknowledges the
support of Nancy Pollock and Mary Law of the
CanChild Centre for Disability Research in Hamilton,
Ontario.
This information appeared in the May/June, 2002 issue
of Occupational Therapy Now magazine published by the
Canadian Association of Occupational Therapists.
For further information regarding the full literature
report, visit the CanChild web site, click on Keeping
Current at www-fhs.mcmaster.ca/canchild.
