OCCUPATIONAL THERAPY

In pediatric occupational therapy (OT) there is considerable overlap with physical therapy.Many children with disabilities related to cerebral palsy or spina bifida are easily recognized to need OT.There are, in addition, many children with more subtle defects that interfere with fine motor, sensory, or cognitive development that might benefit from OT.The emphasis of the therapist is to help in the overall functional performance that is age appropriate.The two theoretical approaches to OT are sensory intergration (SI) and neurodevelopmental therapy (NDT).SI dysfunction relates to abnormal sensory function related to touch, proprioception, and kinesthetics as well as to vision, hearing, and taste.The concept relates to developmental dyspraxia, which results in poor skill in dressing and eye-hand functions.NDT relates to functional movement that results from reflex and postural responses.Neonates are evaluated using the Brazelton Neonatal Behavioral Assessment Scale.Infants are evaluated using the Bayley Scales of Infant Development and the Peabody Motor Scales.

                Positioning strategies are used in the neonatal intensive care unit to help posture and muscle tone.The therapist can help the family to become comfortable in infant feeding and handling.In the first few years of life, the problems relate to fine motor coordination skills especially of the hands.The therapist will assist by devising specific exercises that involve games and play to learn the skill to achieve the developmental milsetones.

                Preschool children benefit from interventions that ready them for school activies.Using paper and pencil and dressing and eating are skills that should be able to be learned during this time.The school-age children and adolescents who need OT will often be identified by the school.Interventions in the area of coping in activities of daily living and developing independence may be indicated.

ENVIRONMENTAL CONTROL UNIT

An environmental control unit (ECU) is a device that helps to operate electrical or mechanical devices for patients with motot impairment.The equivalents are the remote-control devices used to control garage doors and electronic equipment.The purpose of an ECU is to improve the capabilities of the disabled individual.There are direct devices as well as radio-controlled (wireless) devices that can be activated by touch, voice, computer, or even eye movement.They need to be age-appropriate and feedback is sometimes necessary to show that activation has accured.

WHEELED MOBILITY

For some patients the primary purpose will be to achieve independent mobility.For other it is a means of transportation in which someone else provides direction and control.The wheelchair may be manually propelled or electric.The standart manual wheelchair has two larger wheels with two forward swiveling wheels for direction.Newer lightweight models are designed for recreational use and athletic competition.Powered wheelchairs tend to be restricted to order children who have no potential for walking.

POSTURAL SUPPORT SYSTEMS

Adaptive seating systems are designed to provide postural support to achieve stable sitting particularly if there is poor muscle control or musculoskeletal misalignment.There is flexion of the hips, knees, and ankles to 90  although if there are contractures or deformity, particularly of the spine, the right angle may not be appropriate.There are different levels of support.First is the planar system, which is a flat seat and back, and the next level is the contoured system.The latter provides improved lateral support.The third level is the custom-molded system, which conforms to the body of the patient.The purpose is to provide support and to relieve pressure.The seat is improved with some lateral contouring and the back si slightly curved for lateral stability.If pelvic stabilization is necessary, a seat belt, either over the thighs or in front of the hips, will help.Additional support may be needed laterally for the legs and the head.

Assistive Technology

Equipment and devices are used extensively in physical therapy to aid in improving function.There are a wide range of assistive devices which vary from simple splints to computer-controlled functional limbs.There are four major types of devices: postural support, wheeled mobility, environmental control units, and alternative communication devices.

                The team evaluating the individual patient will make recommendation for specific devices.Justification for the expense needs to be made to the provider.Providers of rehabilitation equipment are a section of the National Association For Medical Equipment Suppliers.There is a national registry of suppliers who meet standarts of practice.

                Performance and skills are assessed and the equipment that has the potentialto help the problem is identified.Realistic goals should be established to demonstrate improvement.Funding is applied dependent upon the various options which include federal, state, and local agencies as well as private insurance.