Occupational Therapy: What does an OT do? An overview of Wirral Paediatric OT Services

1. Wirral University Teaching Hospital NHS Foundation Trust Occupational Therapy:What does an OT do?An overview of Wirral Paediatric OT Services Carol Atkinson CHILDRENS Occupational therapist & Advanced sensory integration practitioner

2. What is Occupational Therapy?A quick recap

3. Occupational Therapy Philosophy: “Occupational engagement is central to our physical and mental health and well being” We are what we do

4. What does an OT do? “An OT’s job is to enable people to do the things that they need or want to do”

5. What does an OT do? • Evaluate what are the boundaries to successful participation • Provide advice or direct intervention to overcome these difficulties • Advice / intervention may be associated with: The Person The Environment The Occupation (activity / task)

6. Paediatric OT Services in Wirral: NHS Teams: • EARLY YEARS OT TEAM • COMPLEX PHYSICAL DISABILITY OT TEAM • SENSORY MOTOR OT TEAM

7. Early Years OT Team • Based at Clatterbridge Hospital • 0 – 4 year olds • Complex, severe or enduring physical / developmental conditions that significantly affects ability to achieve potential in activities of daily living • Referrals via referral form from healthcare or education professionals (e.g. foundation consultants, nursery managers) • Do not directly assess sensory processing difficulties or provide direct treatment for sensory integration difficulties (general advice re: sensory strategies as part of a functional assessment are provided).

8. Complex Physical Disability Team • Based at LeasoweMillenium Centre • 5 – 19 year olds with complex physical or learning disability • Referrals from School Nurse or Social Care • Assessments completed in home / schools • Sensory Integration assessments for complex pupils already in Specialist schools. VERY LIMITED service with 1 x OT trained (4 hours / week available).

9. Sensory Motor Team: Motor Skills • Motor Skill assessments for 4 – 12 year olds • Medical referral required (paediatrician or GP), ABC checklist completed by school (red or amber zone scores indicate risk of motor difficulty) & child needs to meet criteria for potential diagnosis of Developmental Coordination Disorder (DCD) • Assessment completed via hospital clinic appointment. If motor difficulties parent / carer invited to education evening and 12 week group motor skill programme at Clatterbridge • Limited enhanced Sensory Integration service available for children with significant motor skill / modulation needs who have not made expected progress in group treatment. 10 weeks of 1:1 sessions 3 x per week using Ayres Sensory Integration (ASI) approach

10. Sensory Motor Team: Sensory Pathway • 4 – 18 year olds mainstream school • Significant Sensory Modulation Difficulties • Paediatrician or Psychiatrist referral • Provides generic information to parent / carer / school staff and does NOT provide individualised assessment or treatment plan • Parent / Carer invited to 3 hour sensory education talk. Given exercises and a diary to complete. After 2 weeks can book feedback session with OT. If exercises have helped school can opt in to request OT visit to school to advise on activities to incorporate into school day

11. What is Sensory Integration? • Sensory integration is “the organisation of sensation for use” (Ayres 1979) • It is an automatic neurological process • The brain processes the information coming in from the senses, puts it all together to “make sense of it” and then sends the body signals about how to respond and do things

12. Introduction to the senses: Sensations from outside the body: SOUND, SIGHT, TASTE, SMELL, TOUCH PROPRIOCEPTION (body position) VESTIBULAR (gravity, head movement, balance) VISCERAL SENSE (internal organs) Sensations about where the body is in space and how it is moving: Sensations from inside of the body:

13. The Building Blocks of Learning:

15. Assessment:

16. What happens if there is a sensory integration difficulty? Traffic jam of sensory information Sensory information gets “stuck in traffic” or goes the wrong way. The brain does not get the correct information to react as it should This can impact on learning and behaviour

17. Sensory Processing Disorder Sensory Modulation Disorder Sensory-based Motor Disorder Sensory discrimination disorder Sensory over responsivity Sensory under responsivity Sensory seeking Dyspraxia Postural disorder Vision, touch, smell, taste, hearing, movement Types of Sensory Processing Difficulties Figure 1.1 Classification of Sensory Processing Disorder Patterns and Subtypes (Miller 2006)

18. Types of Sensory Intervention: Ayres Sensory Integration: • Aims to work on the child’s underlying neurological processes to improve sensory integration “from within” to support improved participation in day to day occupations. • Needs to be completed by an accredited therapist in specialist clinic • Child led, playful, “just right” challenge Sensory Based Strategies: • Makes accommodations to enable the child to deal with their sensory difficulties • May include environmental modification (ear defenders, quiet space etc) • Includes “sensory diets” and sensory based activities

20. carolatkinson@nhs.net Direct line: 0151 482 7951