What is occupational therapy?
Occupational therapy deals not only with the fine motor aspects of a child’s daily living, but also with the aspects you don’t think about such as proprioceptive and vestibular senses. You might be asking, what are the vestibular and proprioceptive senses? These are how we feel ourselves in space. Let’s first talk about proprioception and vestibular senses and fine motor delays, and then we can talk about how an occupational therapist would help with these disorders. https://www.aota.org/About-Occupational-Therapy/Professionals/CY/Articles/Early-Intervention.aspx
Proprioception is the ability of the body to sense its self in space. Vision plays a role in the body’s ability to sense itself in space, but vision is not completely necessary to know where one’s body is. Try closing your eyes. If you do not have proprioceptive dysfunction, you should be able to stay in relatively the same spot without slumping over. You should also know “I am on the floor.” Or wherever you are. Children with proprioceptive dysfunction feel scattered and these may be the kids you see trying to help this feeling by playing roughly, jumping, running in to couches and crashing, etc. They are trying to regulate their proprioceptive input. An Occupational therapist can help you with safe ways for them to do this. https://www.brainbalancecenters.com/blog/2015/08/proprioception-explained/
A child who has had a transplant may have proprioceptive dysfunction due simply to the fact of being sedated for long periods of time and not being able to be touched or move around much if at all. When a child is pre-or post-transplant, they may spend long periods bedridden and on heavy medications. Some of these medications can lead to short periods of proprioceptive delays as well.
The vestibular system detects movement and where the head is in space. It also detects how fast or slow you are going. The vestibular system is needed for the entire nervous system to function correctly. One effect of a vestibular disorder is low muscle tone. This can lead to tings like not being able to write correctly, not learning to walk as soon as other children, and being clumsy and falling more often than other children. A child with a vestibular dysfunction will also be more afraid because they are unsure if they are going to fall due to not being aware of where their body is in relation to the ground. Think of the last time you had an ear infection. You may have felt a little dizzy, your head felt a little fuzzy and the ground may have felt like it wasn’t in the right space. This is similar to what a child with vestibular dysfunction feels. Except antibiotics won’t cure it. But a good occupational therapist can help! Because children are different from adults, when a child has a vestibular dysfunction, these are the children you may see spinning around, or conversely trying not to move. They may bang their head a lot, or avoid having things on their head. They may have a lot of problems with balance and difficulty walking. http://nspt4kids.com/healthtopics-and-conditions-database/vestibular-processing/
Children that are pre-or post-transplant are especially prone to vestibular dysfunction due to the simple fact that they may not be up and about while waiting for their organ. They also are on heavy medications and may not have many people touching them due to not wanting to acquire infections. All of these factors come together and you can have a child that gets out of the hospital and has a vestibular dysfunction. The good news is that once they are cleared to do normal activities, a good occupational therapist will be able to give you activities to do with your child at home to help them regain good vestibular modulation. These can be things like pushing and pulling a stroller with heavy items in it (if the child is walking), or pressing on your child’s arms and legs to provide input. You can also put your child in a swing at the park, or make a swing out of blankets and swing your child to help provide input.
Fine Motor Skills
The other thing that Occupational therapists work on is fine motor skills. Fine motor delays can be due to many different things. It can be due to low muscle tone, or loss of muscle due to being bedridden. Muscles in the forearm control the fingers and hand, which is why you see babies grasping items with their whole hand. If they aren’t able to develop this task first, they will have difficulty later on developing a pincer grasp to pick up small items like cheerios when they are learning to self-feed, which leads to greater delays along the line. This is why it is best to get started in Early Intervention as soon as possible. Obviously if your child is waiting for a transplant, they are not working on using their muscles as much as a typically develop child their same age would be. They are worrying about essential skills such as breathing and organ function. When the child has been cleared by their medical team, if you notice such things like they are not able to pick up large items with their whole hands by about 8 months, and smaller items but about 1 year, or they are not able to use a pincer grasp by about 1 year, call your local child and family connections to get an evaluation by an occupational therapist.
The therapist will work with you in your natural environment on ways to help increase muscle tone in your child’s core. This may not seem like it is necessary. You may be thinking, why would my child’s core need to be strengthened if their fine motor skills are what is delayed. But if a child has weak core muscles then that weakened muscle tone, is not going to allow her to sit up straight, and thus weakening her positioning for any fine motor tasks. This will also come in handy when the child starts to crawl. We will go more in depth with this as well in the Physical therapy section. But, if a child has a weak core, they are not going to be able to support themselves when they are in quadruped position. They are also going to need more support in their hands as well as someone to help hold their tummy, thus making crawling a little more difficult. Your Occupational therapist should be able to assist you in ways to strengthen your child’s core muscles as well as the muscles in their hands and forearm so that they can participate in all for their daily play and living skills in your family.
-Written by Stacy Hillenburg (parent of transplant recipient and Early Intervention Specialist)
-Additional resources added by Corrine Trenholm OTR/L