Occupational therapy encompasses a wide range of treatments and interventions for both physical and neurological disabilities that might interrupt a child’s ability to go about their daily life. OTs may work on the following skills:
Fine motor skills are needed to control the movement of our hands and fingers as well as the muscles in our face, tongue, and feet. We use fine motor skills for activities such as grasping objects, tying shoes, writing, and using scissors.
Crossing the midline means moving one’s arm and leg across the middle of the body — this simple movement can improve communication between the left and right hemispheres of the brain, and it’s important for nearly everything we do.
Hand-eye coordination not only helps us process visual information; it’s also needed for tasks such as stacking blocks, throwing a ball, or typing on the computer.
Executive functioning is the ability to plan, initiate, organize, remember, and connect information; better executive functioning skills can help kids shift mindsets, set goals, and self-monitor.
Sensory processing helps us make sense of our body in the environment; sensory integration therapy (SI) helps a child cope with challenges processing sensory input by using proprioceptive play (swings, trampolines, slides), body work (weighted blankets, brushing, massage), and more. A OT may also design a “sensory diet” of sensory activities for your child to do each day to help boost their attention, arousal, and adaptive responses.
Feeding therapy is used to teach a child with sensory or motor challenges how to eat, or to eat more effectively. It may be administered by a speech-language pathologist (SLP), occupational therapist (OT), or both working together. While an SLP might focus more on swallowing and upper gastrointestinal dysfunction, an OT will consider the total-body picture such as posture and the need for adaptive devices.
Nutritional support therapy is used to treat or prevent malnutrition in children who cannot eat enough food. There are two types of nutritional support therapy: enteral nutrition and parenteral nutrition. Enteral nutrition uses a feeding tube, while parenteral nutrition uses a tube inserted directly into the veins in cases where the digestive tract can’t be used. The method, amount, and type of nutrition used all depend on each individual child’s needs.
VitalStim Therapy uses neuromuscular electrical stimulation to treat dysphagia, or difficulty swallowing. A video-fluoroscopic swallow study is typically used beforehand to figure out if your child is having trouble swallowing. During the therapy sessions, electrodes will be placed on the front of your child’s neck, and your child will be encouraged to swallow food or liquids while an electrical current is administered through the electrodes.
Physical therapy uses prescribed exercises and hands-on care to treat a range of injuries, disabilities, and other conditions that affect a child’s ability to learn and use the large muscles (arms, legs, and torso) in their body — otherwise known as gross motor skills. By working to improve gross motor skills, physical therapists can help decrease muscle pain and improve strength and range of movement through developmental activities like crawling or walking, adaptive play, water therapy, flexibility exercises, and more.
Cuevas Medek Exercises are used to improve gross motor skills in children with non-degenerative movement disorders and physical disabilities that affect their ability to walk, sit, or stand on their own. PT and CME therapist Dr. Alyssa VanOver explains that CME “exposes kids to anti-gravity in a way that’s unique from traditional therapy.” Rather than provide support at the trunk, or mid-body, she says, a CME therapist supports a child distally, at the hips, legs, or feet while guiding them through a series of exercises. VanOver explains that providing distal support “activates postural control responses as they pertain to head and neck control, trunk control, and standing control that we don't think about on a day to day basis.” This encourages better balance and core strength as a child grows. “CME uses a series of exercises to provoke those postural control responses, as they pertain to head and neck control, trunk control, and standing control."
CME can be used as early as three months old. While VanOver says that CME can be applicable to most children, it is not recommended for a child who has any sort of progressive disorder, or something like osteogenesis imperfecta or a serious hip subluxation, because it’s very demanding. “If your child is exposed to something that is too intense, it actually can have a detrimental effect,” she says.
Gait training is a type of physical therapy that aims to improve a child’s ability to walk. It can be helpful for children with neurological disorders such as cerebral palsy, which affects reflexes, muscle tone, and rigidity. This type of PT can also benefit children with developmental disorders or conditions that cause irregular gait, such as toe walking.
The methods used for gait training may differ depending on your child’s individual needs. Different devices and tools like treadmills, postural supports, spider cages, and electronic stimulation can be used depending on the situation. One such device is the ZeroG system, which supports an individual’s body weight so they can safely practice their gait. When using ZeroG, the patient will be placed into a harness, which is suspended from a track overhead.
Hippotherapy is any therapy — physical, occupational/sensory, or speech-language pathology — that incorporates the use of a horse. As VanOver explains, hippotherapy can be great for children with high muscle tone because simply sitting with their legs apart on a horse provides a great stretch. Hippotherapy is also great for improving balance and trunk and head control because the horse’s gait pattern mirrors our own. She explains, “The trajectory that a horse’s center of gravity follows is the same as ours, so riding exposes a child to the same types of weight shifts that you would experience if you were walking over that period of time, and it allows your trunk to respond to that.”
IMOT is a type of PT used to treat children with cerebral palsy and other neurological disorders. It involves using short, intense sessions of therapeutic exercises for a defined period of time. The time frame and length of intensive sessions will vary depending on your child’s needs, tolerance, and medical issues.
During therapy, the child works on strength and conditioning, improving motor function, and reducing unwanted reflexes. Recent studies indicate that IMOT is more effective than traditional PT for children with spastic cerebral palsy.
Different tools and equipment are used to facilitate IMOT. Many PT programs use the NeuroSuit in combination with a spider cage, which helps maintain proper alignment of the body during movement and redistribute the child’s body weight so that they can focus on proper movement while building strength and motor skills.
A NeuroSuit is made of a vest, shorts, knee and elbow pads, gloves, shoe attachments, and sometimes a hat with hooks on it. Bungee cords are attached to these hooks to support the proper alignment of your child’s body. It can be used to reduce or increase pressure and distribute weight, and is often used to help those with cerebral palsy, global developmental delays, ataxia, chromosomal disorders, and more.
The spider cage is a wire mesh device that uses bungee cords attached to a harness. This allows your child to practice functional skills while developing strength and balance. It may be used with treadmill training to support gait training or as a part of another therapy. The name “spider cage” refers to the eight bungee cords used to attach a child to the frame.
Stretching is intended to increase range of motion while reducing joint and muscle stiffness. To achieve this, therapists may use manual stretching exercises, orthotics, casting, standing tables, or a combination thereof. Some physical therapy programs may use stretching to treat and prevent contractures, or tightening. There is some disagreement among experts on whether manual stretching is an effective PT intervention for children with cerebral palsy.
Like the NeuroSuit, TheraTogs are an external support system that a child wears (sometimes as an undergarment) during therapy to promote alignment. VanOver tells us that the while NeuroSuit came out of Europe, TheraTogs were created by a physical therapist in the United States. “It acts kind of as an extra set of hands,“ she explains. “As a therapist, I always say I wish I had eight more hands, and that’s kind of what the TheraTogs intention is: let’s support you in the best alignment that we possibly can, and then the therapist can focus more on the action movements as opposed to holding the alignment.“
Treadmill training, or treadmill gait training, is a PT technique that uses a treadmill to assist your child with learning to walk, building strength, and increasing coordination. It is typically used for children with neurological and developmental diagnoses such as cerebral palsy and Down syndrome.
While speech therapy is concerned with voice and speech-language skills, hearing therapy (also referred to as audiology) deals with hearing and hearing impairment. Speech and hearing therapies are used to help children with voice disorders, language disorders, stuttering, and aphasia. An SLP can evaluate your child’s language skills to establish an individualized treatment plan.
AVT is an early intervention therapy option for infants, toddlers, and young children who use hearing aids or cochlear implants. An AV therapist will work with a child to help them listen and develop spoken language skills. AVT also helps family members learn methods to stimulate their child’s potential for hearing.
ASL is a complete visual language that uses hand and body movements as well as facial expressions to communicate. It has its own unique grammar, which is distinct from that of spoken English.
Total communication is a system that works to provide children with hearing loss with the tools to communicate and express themselves, including using gestures, body language, sign language, augmented communication devices, lip reading, and cued speech.
Vision therapy is a broad term for a therapy program that attempts to improve visual skills and abilities. It can be used to prevent or correct myopia (nearsightedness), strabismus (when both eyes do not line up in the same direction), and diplopia (double vision). It involves eye exercises used by pediatric opthamologists and orthoptists that can be taught at the doctor’s office and repeated later at home. Vision therapy may also be used to treat visual processing disorders in children with learning disabilities, dyslexia, and ADHD.
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