Case Study

Presentation
OCCT 657A

Presented by: Natasha Arastehmanesh,

OTS
Touro University Nevada

Placement Setting
Los Angeles Unified School District (LAUSD)
School based
Elementary school
Preschool- 5th grade

LAUSD. (2015). Retrieved from:

http://home.lausd.net/apps/pages/index.js
p?
type=d&uREC_ID=170896&pREC_ID=351
710

School-based OT

Occupational therapy services must be educationally relevant

by contributing to the development or improvement of the
childs academic and functional school performance (Bazyk &
Case-Smith, 2010).

Areas OT address
Postural stability
Fine motor skills
Visual perception and integration
Activities of daily living
Motor planning
Coordination
Sensory processing
Self-help activities
Social and play abilities
Environmental adaptations
Use of assistive devices

Pinterest. (2016). Retrieved from:

https://www.pinterest.com/pin/605178072
6718089/

2010)

(Bazyk & Case-Smith,

Student
Age: 6 years-old & 4 months
Gender: Male
Grade: Kindergarten
Medical diagnosis: Autism Spectrum Disorder
Eligibility: Developmental Delay
Curriculum: general education
Receives OT 3x/week
Has a BIS for 90% of school day
Related services: speech therapy, and behavior intervention implementation

Background Information
Met most developmental milestones
Did not respond to name
No speech at 18 months
Very high tolerance for pain
No regard for safety
OT services

Areas of Need
Fine motor development
Visual Perceptual/Visual motor integration
Sensory registration/sensory integration

Goals
Goal 1: Student will consistently demonstrate an appropriate grasp
when writing and will be able to form 90% of the letters of the
alphabet while referencing a visual representation in 4/5
opportunities with minimal support.
Goal 2: Student will be able to independently cut out a triangle,
heart, and star with correct finger placement and consecutive snips,
while rotating his paper with his non-dominant hand with verbal
cues/reminders in 4 out of 5 opportunities.
Goal 3: Student will be able to access sensory support (gum,
weighted lap bags, different seat) within the classroom when needed
to stay engaged in an activity without seeking it from touching the
children near him or by leaving the activity in 4/5 opportunities.

Treatment strategies
Pencil Grip
Short pencil with a grip
Stabilizing a penny in his palm (with his pinky and ring finger)

Bilateral coordination
Building with Lego, pop beads, stringing beads and lacing cards, play dough with
rolling pins and a play dough pump, links, snipping straws and play dough logs,
bristle blocks etc.

Handwriting
Have him practice writing skills in tactile substances such as salt trays, shaving
cream, finger paints, magna doodle, and specific IPad/tablet apps. He can also
form letters by building 3D structures-such as making letters out of blocks or
play-dough logs.

PEOP
P-Person
E-Environment
O-Occupation
P-Performance

PEOP. (2015). Retrieved from:

http://handtherapycanbefun.weebly.com/peop-model.html

(Crepeau, Boyt Schell, & Cohn, 2009)

Person-Intrinsic Factors
a) Neurobehavioral

Sensory seeking

Fine motor difficulties

Praxis-sequencing tasks

b) Physiological

ROM & Strength

c) Cognitive

Poor attention

d) Psychological

Motivation-IPAD

e) Spiritual

Jewish

(Crepeau, Boyt Schell, & Cohn, 2009)

Environment-Extrinsic Factors
a) Built

Many accommodations

b) Natural

Canfield ES

c) Cultural

Student

d) Societal

Attend school

e) Social interaction

f)

Teachers, interdisciplinary team & related services (BI)

Family

Social and economic system

IDEA (Part B)

(Crepeau, Boyt Schell, & Cohn, 2009)

Occupation
a) Abilities

Able to be redirected

Committed team (family, IDT)

b) Actions

Leaning on items

Poor body awareness

Poor visual attention

Poor praxis

c) Tasks

Games & Activities

d) Occupations/social and occupational roles

Student

(Crepeau, Boyt Schell, & Cohn, 2009)

Performance
Delays
Fine motor/grasp
Handwriting

Sensory processing
Arousal level
Bilateral coordination
Praxis

Handwriting. (2015). Retrieved from:

http://www.healthline.com/health/adhd/handwriting

(Crepeau, Boyt Schell, & Cohn,

2009)

Cognitive Behavioral FOR

Top-down, occupation based approach
Banduras idea of self-efficacy
Discovers specific strategies applicable to tasks that they needs to perform
Guided to develop their own cognitive strategies based on problems
encountered during tasks.
Strategies unique to each individual
Utilizing cognitive skills to assess performance
Identify successful and unsuccessful actions
Change occurs when the clients is able to cognitively acknowledge that a
change must occur.
(Case-Smith, Law, Missiuna, Pollock & Stewart, 2010)

Cognitive Behavioral FOR cont.

The therapist does not give instructions, rather uses questions
to help children
1. Discover the relevant aspects of the task
2. Examine how they are currently performing the task
3. Identify where they are getting stuck
4. Creatively think about alternative solutions
5. Try out the solutions and evaluate them in a supportive environment

(Case-Smith, Law, Missiuna, Pollock & Stewart,

2010)

Alert Program
Alert Program (AP) helps children
learn to monitor, maintain, and change
their level of alertness so that it is
appropriate to a situation or task
(Williams & Shellenberger, 1996, p.1-1)
Cognitive approach to teaching selfregulation
Children with learning disabilities 8-12
years old but has been adapted for
preschool through high school
students.
Individually or in group settings

Alert Program. (2016). Retrieved from: http://lifespantherapies.com/thealert-program-for-self-regulation/

(Williams & Shellenberger, 1996)

Alert Program
AP is designed to
1. Teach how to recognize arousal states as they relate to
attention, learning and behavior
2. Help children recognize and expand the number of selfregulation strategies
3. Give a framework (vocabulary, activities, and environment)
to help children recognize and regulate their own arousal
states
(Williams & Shellenberger, 1996)

Alert Program
Analogy of an automobile engine to introduce its concepts of
self-regulation to students
Your body is like a car engine, sometimes it runs on high,
sometimes it runs on low, and sometimes it runs just right
AP has 3 stages:
1. Define and label how their engine is running
2. How to change engine levels utilizing sensorimotor
strategies
3. Monitoring sensorimotor input to regulate arousal level
1996)

(Williams & Shellenberger,

How does your engine run?

Analyzing theories
PEOP & Cognitive Behavioral FOR
Evaluation
School setting

Intervention planning/implementation
Behaviors, arousal level

Outcomes
Occupational improvement
Participation
Successful student

(AOTA, 2014)

References
American Occupational Therapy Association.(2014).Occupational therapy practice framework:
Domain and process (3rd ed.).American Journal of Occupational Therapy, 68(Suppl.1), S1
S48.http://dx.doi.org/10.5014/ajot.2014.682006
Bazyk, S., & Case-Smith, J. (2010). School based occupational therapy. In J. Case-Smith, &
OBrien (Eds.), Occupational therapy for children (6 th ed.) (p.713-743). Maryland Heights,
MO: Mosby Elsevier

J.C.

Case-Smith, J., Law, M., Missiuna, C., Pollock, N., & Stewart, D. (2010). Foundations for
occupational therapy practice with children. In J. Case-Smith, & J.C. OBrien (Eds.),
Occupational therapy for children (6th ed.) (pp.22-55). Maryland Heights, MO: Mosby Elsevier
Crepeau, E. B., Boyt Schell, B. A., & Cohn, E. S. (2009). Theory and practice in occupational
therapy. In E.B. Crepeau, E.S. Cohn, & B.A. Boyt Schell (Eds.), Willard & Spackmans
occupational therapy (11th ed., pp. 428-434). Baltimore, MD: Lippincott Williams & Wilkins
Williams, M. S.,& Shellenberger, S. (1996). How does your engine run?: A leaders guide to
the alert
program for self-regulation. Albequreque, NM: TherapyWorks Inc.