Occupational therapy: a path to independence in everyday life

Series: Child and therapy - Part 5

Sometimes the children balance back and forth on a sloping surface. Or they practise things that seem completely normal to us adults: Throwing balls, painting, climbing, tying strings or zipping up a jacket. Things that healthy children can do quite easily, children who go to occupational therapy have to practise step by step.

«Experiencing yourself in action has a healing effect,» says occupational therapist Sibylle Klingenfuss.

«Experiencing oneself in action has a healing effect,» says Sibylle Klingenfuss, occupational therapist from Trogen. This principle precisely describes the content of this form of therapy. Occupational therapy: The term comes from the Greek word «ergon», which means «work», «action», but also «labour». Occupational therapy is based on the assumption that being active, doing something or working is a basic human need - even for children. In developmental psychology, this is called «self-efficacy». A child experiences itself as self-efficacious if, for example, it has an idea for a game, can realise it and experiences that this game gives it and others pleasure.
Children also experience their own bodies during free play. When they hurtle down a slide or swing high into the air on a swing board, this trains their body awareness, sense of balance and coordination of movement. Making a paper aeroplane or colouring in a figure requires the child's fine motor skills. However, not all children can race down the slide, cut things out and glue them together at school. Some lack fine motor skills, others lack concentration or stamina, while others are not yet ready due to their development.

This is where occupational therapy comes in. Occupational therapists try to «empower» children and teach them the skills they lack through basically simple activities such as painting, games, handicrafts or movement exercises and lots of individual attention. This leads to improvements if there was previously a lack of stimulation. This is because many children sit in front of the television or an iPad for hours every day and only consume passively, i.e. they do not become creative themselves, play outside and learn their skills in free play alone or with other children. The objection raised by parents or doctors against speech therapy treatment, for example, that some children simply need more time, is only partially valid in the case of occupational therapy. This is because the American Psychiatric Association established back in 2013 that children with attention deficit disorder (ADHD), circumscribed motor development disorder (UEMD) and other learning disabilities (LD) have impairments in their bodily functions that significantly affect their ability to perform and manage everyday tasks and activities at school, at home and in their free time.

Making everyday life easier

In simple terms, occupational therapy aims to make life easier for children, their everyday life at school, at home and in their free time. Whenever possible, occupational therapist Sibylle Klingenfuss starts with a goal that the child formulates themselves. This could be, for example, to stop being afraid of balls being thrown at them in gym class, to stretch up first at school and only then speak instead of the other way round or to be the first to speak at break time.

Missing skills should be taught through simple activities and lots of individual attention.

The latter was a specific goal of one of her clients. The boy really wanted to play football with his mates during the break. But because he lacked fine motor skills, it took a long time for him to get to the playground - taking off his boots, putting on his shoes and tying his shoelaces, putting on his jacket and zipping it up all took time. As a result, he was always the last one in his class to leave for the break and never had a chance to play a football match together. This in turn frustrated him so much that he was sometimes angry and aggressive, sometimes sad and meek.

Whenever possible, the occupational therapist starts with a goal that the child formulates themselves.

«This boy's goal was to be first one day. So that's exactly what we practised over and over again,» says Klingenfuss. In concrete terms, this meant taking off his shoes, putting on his jacket, fastening it and putting on his shoes. And they thought together about what would help them achieve this goal: shoes with Velcro fasteners instead of laces, for example. No jacket with a zip or buttons. So that the boy is not the last to arrive in the classroom after the break, they also practised the opposite: taking off his jacket and hanging it up, taking off his shoes and putting them down, putting on his heels.

Klingenfuss finds it ideal to link a so-called short-term goal (in this case, improving fine motor skills) with a specific long-term goal that is important to the child. «I work with motivation and joy. Play is often an approach to this, so you could talk about learning through movement.»

According to Klingenfuss, it is important to work in a resource-orientated way, to take pressure off the child and to enable a sense of achievement. She once worked with a child who had great difficulties with gross and fine motor skills. She built a wooden ship with him. The first step was the rough work - cutting the material to size, drilling the holes for the portholes and the sail masts, hammering in the nails, and only at the very end was the ship carefully painted. From the rough to the fine: these work steps, adapted to the child's pace, abilities and stage of development, were important. Because, like psychomotor skills, occupational therapy takes a holistic, playful approach.

The therapist comes home

What many people don't realise: Occupational therapy does not always have to take place in the practice. If indicated, the therapist will also come to the child's home. This is because environmental factors are just as important: does the child have a quiet place to themselves, a place to learn? Does it listen to music on the side, is this music too loud? Depending on the situation, how can the parents be involved, motivated or, if necessary, relieved? Close dialogue with the parents is also important. After all, it is the parents who ultimately decide whether their child receives occupational therapy.
The recommendation for therapy often comes from a teacher or paediatrician. The child's current problems and the goals of possible therapy can then be evaluated in an assessment. Various standardised procedures and tests are available for this purpose, which are adapted to the relevant issue.

Like psychomotor skills, occupational therapy takes a holistic, playful approach.

Occupational therapists carry out detailed assessments at the start of therapy to enable individualised treatment. They discuss the therapy goals with the child and their parents and liaise closely with all those involved (parents, doctors, teachers and other specialists). Critics of occupational therapy sometimes criticise its lack of effectiveness in paediatrics. In fact, there are still too few evidence-based studies, especially studies in the early years. Occupational therapist Brigitte Gatschnig analysed 36 systematic studies on occupational therapy and the most common therapy fields at the ZHAW. In 13 studies, strong evidence was found for the effectiveness of occupational therapy interventions for children with ADHD, UEMF or LD.

Who pays for occupational therapy?

Occupational therapy is a medical-therapeutic measure at the interface between education and medicine. It supports children and young people whose physical and mental development is impaired or slowed down. The task and aim of occupational therapy is to improve the ability to act in everyday life and thus also at school, to promote independence and to ensure participation in everyday life and in lessons. The diagnosis is made by a doctor, the therapy is prescribed by a doctor and is covered by health insurance and disability insurance.

The catalogue of measures

Occupational therapists support children and young people with the following measures:

• Enabling and practising age-appropriate skills such as dressing, eating, cycling, writing, playing, etc.
• Promoting the absorption and processing of sensory information (sense of touch, body awareness, balance)
• Functional and activity-orientated promotion of gross and fine motor skills
• Teaching action-supporting strategies such as focussed attention, planning and control
• Promotion of social and emotional skills
• Training of visual, auditory, spatial and memory-related skills as prerequisites for the ability to act
• Aids counselling and adaptation, production of splints
• Parental and environmental counselling, prevention

Source: www.ergotherapie.ch

Occupational therapy and ADHD/ADS/ASS

In Switzerland, 60,000 to 70,000 schoolchildren have been diagnosed with ADHD. These children often not only suffer from an attention deficit and hyperactivity, half of them also have a motor development disorder. The affected child's brain absorbs all stimuli from the environment unfiltered and is unable to distinguish between important and unimportant things. This sensory overload cannot be adequately processed, resulting in behavioural disorders. This is often compounded by partial performance weaknesses such as dyscalculia or dyslexia, which place an additional burden on patients. Not only does the child's self-esteem suffer, but relationships with parents, siblings or friends can also be affected, explains occupational therapist and ZHAW researcher Brigitte Gantschnig. Occupational therapy for ADHD usually first addresses existing disorders in perception and motor skills. Those affected get to know their body and their limits better in a protected environment. The aim is to achieve a structured way of working, improve gross and fine motor skills and the ability to write legibly and pay attention to lines. The absorption and processing of sensory stimuli, communication skills and social skills are improved. Learning to work in a structured and organised way is also practised in occupational therapy for ADHD. «Occupational therapists observe and assess the children's strengths and difficulties in everyday life and build interventions on this. These enable them to carry out everyday activities as independently and satisfactorily as possible,» says Brigitte Gatschnig.
Source: www.zhaw.ch

Read more about therapy:

• Wann braucht mein Kind eine Therapie?
  Ein Kind hält den Stift nicht richtig, ein anderes kann beim Turnen nicht auf einem Bein hüpfen – diese Dinge kommen im schulischen Standortgespräch im Kindergarten zur Sprache. Oft folgt ein Therapieangebot: Welche Therapieformen gibt es und wie sinnvoll sind diese?
• Medikamente gegen Stress: Wann kann ein Kind selbst entscheiden?
  Ist ein Kind noch nicht fähig, ein eigenes Urteil zu fällen müssen Erwachsene über medizinische Behandlungen entscheiden. Doch wann ist ein Kind urteilsfähig? Ein Wegweiser durch den juristischen Dschungel.
• «Nicht schon wieder schreiben»
  Für Kinder mit einer Lese- und Rechtschreibschwäche ist das Lesen und Schreiben ein «Chnorz». Die Logopädin Andrea Weber-Hunziker über Anzeichen und Ursachen und wie das Lernen in der Schule trotzdem gelingen kann.