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Occupational Therapy Roles in the Interdisciplinary Treatment of Learning Disabilities: Theoretical Model and Clinical C

Occupational Therapy Roles in the Interdisciplinary Treatment of Learning Disabilities: Theoretical Model and Clinical Case Study. Tim Conway, Ph.D. The Morris Center, Inc. University of Florida Gainesville, Florida Lorie Richards, Ph.D., OTR/L University of Florida Gainesville, Florida.

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Occupational Therapy Roles in the Interdisciplinary Treatment of Learning Disabilities: Theoretical Model and Clinical C

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  1. Occupational Therapy Roles in the Interdisciplinary Treatment of Learning Disabilities: Theoretical Model and Clinical Case Study Tim Conway, Ph.D. The Morris Center, Inc. University of Florida Gainesville, Florida Lorie Richards, Ph.D., OTR/L University of Florida Gainesville, Florida www.TheMorrisCenter.com

  2. WHAT DYSLEXIA IS NOTDYSLEXIA… • .. is NOTA VISUAL PROBLEM • .. is NOTA LACK OF INTELLIGENCE • .. is NOTDUE TO LACK OF EFFORT • .. is NOTA DEVELOPMENTAL LAG • .. is NOTUNCOMMON: 5–17.5 % OF POPULATION • .. is NOTRESPONSIVE TO STANDARD READING INSTRUCTION

  3. DYS = TROUBLE LEXIA = WORDS DYSLEXIA IS… • NEUROLOGIC IN ORIGIN – GENETIC • LIFELONG – ENVIRONMENT MAY ALTER COURSE • CORE DEFICIT=PHONOLOGICAL AWARENESS (LANGUAGE) • READING COMPREHENSION > WORD READING SKILLS DYSLEXIA MAY INCLUDE ACCOMPANYING CHALLENGES • ADHD (50-70%) • BEHAVIORAL PROBLEMS • SENSORY MOTOR DIFFICULTY • = MORE CHALLENGING TO REMEDIATE

  4. THE PICTURE OF DYSLEXIA (ALL STENGTHS DO NOT OCCUR FOR EVERYONE) STRENGTHS LEADERSHIP SKILLS THINKING “OUT OF THE BOX” CHURCHILL THOMAS EDISON JFK TED TURNER POLITICAL & MILITARY SCIENTISTS & INVENTORS PATTON BUSINESS

  5. THE PICTURE OF DYSLEXIA (ALL STENGTHS DO NOT OCCUR FOR EVERYONE) STRENGTHS CREATIVITY WRITERS ACTORS/DIRECTORS ARTISTS MUSICIANS DaVINCI H.C. ANDERSEN MOZART SPEILBERG / FORD

  6. THE PICTURE OF DYSLEXIA (ALL STENGTHS DO NOT OCCUR FOR EVERYONE) STRENGTHS VISUOSPATIAL / MOTOR SKILLS SURGEONS ATHLETES NOLAN RYAN NEUROSURGERY MOHAMMAD ALI

  7. THE PICTURE OF DYSLEXIA LISTENING SPEAKING Phonological Awareness Word Finding Multi-syllable Words Auditory Memory (word sequences, phone numbers, remembering directions) Sequencing Ideas Foreign Language Foreign Language (ALL SYMPTOMS DO NOT OCCUR WITH EVERYONE) ORAL LANGUAGE CHALLENGES

  8. THE PICTURE OF DYSLEXIA READING SPELLING & WRITING Mechanics Comprehension Mechanics Expressing Ideas Speed Speed (ALL SYMPTOMS DO NOT OCCUR WITH EVERYONE) WRITTEN LANGUAGE CHALLENGES

  9. THE PICTURE OF DYSLEXIA Messy Eating Oral Motor Writing/knots Fingers Lose Place Eyes Words Swim Tired Left/Right Spatial Awareness Up/Down (ALL SYMPTOMS DO NOT OCCUR WITH EVERYONE) ACCOMPANYING SENSORIMOTOR CHALLENGES

  10. THE PICTURE OF DYSLEXIA Attention & Executive Function Brain / Behavior Disorders Anxiety OCD Oppositional Behavior Depression Parents with similar challenges (ALL SYMPTOMS DO NOT OCCUR WITH EVERYONE) ACCOMPANYING CHALLENGES (BEHAVIORAL)

  11. “CHANGES IN SYNAPSES?” AT WHAT AGE DO NEURONS LOSE THE ABILITY TO MAKE NEW CONNECTIONS (SYNAPSES) WITH OTHER NEURONS?

  12. NEURONS- How the Brain Works • How Many Neurons In The Brain? • ~ 100 Billion • How Many Connections Exist in the Neural Networks Formed in the Brain? • ~ 100 Trillion • How Many “Connections” for a Single Neuron? • ~ 40,000 • So, we have an organ that is specifically designed for learning and behavior. Why do some brains “work” differently than others?

  13. VISUAL-LANGUAGE ASSOCIATIONAREA VISUAL / VERBAL AREA SPEECH PRODUCTION AREA AUDITORY PROCESSING AREA LEFT HEMISPHERE TYPICAL LANGUAGE AREAS

  14. WORD ANALYSIS WORD ANALYSIS AUTOMATIC (SIGHT WORD) LEFT HEMISPHERE TYPICAL READING AREAS

  15. METALINGUISTICS WRITING SPELLING READING SYNTAX (FORM) SEMANTICS (MEANING) PHONOLOGY (FORM) PRAGMATICS (FUNCTION) Developmental Building Blocks for Language 9 YEARS 5 YEAR S 18 MONTHS 9 MONTHS 1 MONTH

  16. UNIQUE AND OVERLAPPING NETWORKS SENTENCE/SYNTACTIC, SEMANTIC, PHONOLOGICAL VIGNEAU et al., 2006

  17. NEURONAL MIGRATION NEURAL MIGRATIONGONE AWRY IN DEVELOPMENTAL DYSLEXIA X www.thebrain.mcgill.ca

  18. “OUT OF LINE NEURONS” (ECTOPIAS) FRONT BACK

  19. STRONG ACTIVITY PATTERN weak activation pattern BRAIN ACTIVITY DURING READING “SIGNATURE” DYSLEXIC BRAIN Simos, et al 2002

  20. Treatment = Increased activity in left hemisphere TREATMENT CHANGES the BRAIN’S ACTIVITY Decreased activity in right hemisphere (Simoset al 2002)

  21. Biology (RAMUS, 2004) Cognition Behavior

  22. PHONOLOGY (PERCEPTION & PRODUCTION) EXECUTIVE FUNCTION / INTENTION WORKING MEMORY HOLD / MANIPULATE PROSODIC (WORD LEVEL) PHONEMIC REPRESENTATION ORAL MOTOR SOMATOSENSORY ACOUSTIC VISUAL ATTENTION / AROUSAL

  23. THEORETICAL DEVELOPMENTAL DYSLEXIA: A MOTOR-ARTICULATORY FEEDBACK HYPOTHESIS (HEILMAN, VOELLER, ALEXANDER, 1996) “The inability to associate the position of their articulators with speech sounds may impair the development of phonological awareness and the ability to convert graphemes to phonemes. Unawareness of their articulators may be related to programming or feedback deficits.”

  24. Sensorimotor Pyramid Cognition Academic Learning ADL’s Behavior Perceptual- Motor Auditory Visuospatial Focus Language Perception Attention Eye-Hand Ocular-Motor Postural Coord Control Adjustment Sensory- Motor Body Scheme Reflex Maturity Screen Input Postural Security Bilateral Awareness Motor Planning Olfactory Visual Auditory Gustatory Sensory Tactile Vestibular Proprioception Central Nervous System

  25. Interdisciplinary Team forAssessment & Treatment Disciplines: • Neuropsychology • Psychiatry • Nursing/Nurse Practitioner/Developmental Pediatrics • Clinical Psychology • Occupational Therapy • Speech-Language Pathology • Education

  26. Case Study • High school student • History of dyslexia since elementary school • Parent is a school teacher • Years of school-based academic intervention and specialized tutoring at franchised centers… • Starting athlete with scholarship potential, but he has body function and academic deficits in…

  27. Case Study - Assessment Findings Deficits in: • Attention • ADHD-Inattentive • Language • Phonological • Reading • Writing • Spelling • Written comprehension • Expression. • Sensorimotor • Visual vigilance • Visual tracking • Vestibular • Visual perceptual • “Low Registration” on Sensory Profile • Poor balance with eyes closed • Poor supine flexion.

  28. Case Study: Interdisciplinary Treatments Psychology: • Individual therapy • Therapy with mother Speech-Language: • Phonological Awareness (LiPS Program®) • Mental Imagery (Visualizing & Verbalizing®) • Written Composition (Visual-Kinesthetic Sentence Structure). OT • Sensory modulation & processing - esp. vestibular • Oculomotor skills • Joint stability • Visual perceptual skills • Balance • Movement perception • Sequencing.

  29. Case Study: Interdisciplinary Treatment of Dyslexia Treatment Schedule: • Daily • 4-6 hours treatment per day • ~1 hour of OT • ~3-5 hours language • 5 days per week • ~12 weeks Treatment Hours: • Phonological/Cognitive: ~150 (LiPS®) • Semantic/Memory (V/V®): ~50 • Syntax/Cognitive (VKSS): ~50 • Physical Medicine: ~45.

  30. Body Functions: Visual-Motor Integration (VMI) IQ=101 Standard score

  31. Body Functions: Test of Visual Processing Skills-3 IQ=101 Scaled score

  32. Body Functions: Comprehensive Test of Phonological Processing (CTOPP) Standard score

  33. Improved Body Functions • Sensory Processing – “Low registration” was improved with medication and arousal strategies for use at home and school. • Processing/ Modulation of Vestibular Information - R & L LE balance without vision = 4 and 7 secs, improved to 21 and 18 secs; impaired supine flexion improved to 90 seconds while counting (without holding shoulders); depressed post rotary nystagmus was improved • Oculomotor Skills - losing his place during reading and poor visual endurance (blinked excessively during visual tasks/testing), both visual tracking and endurance were improved and excessive blinking was markedly decreased • Visual Perception -TVPS=83 SS (below average) to TVPS=110 (high average) • Graphomotor Skills - VMI Motor Coordination = 75 SS improved to 89 • Oral Motor Skills - trouble with his oral-motor “feeling” was improved

  34. Academic Functions: WECHSLER INDIVIDUAL ACHIEVEMENT TEST (WIAT-II) Standard score

  35. Conclusions and Future Directions Participant01 Demonstrated: • Improved Body Functions, Academic Functions & school performance (passed high school proficiency tests and will get a standard diploma) • Planning to enroll in Junior College and play sports on an athletic scholarship Future Directions: • More Single-Subject Research Design studies need to be published to document the specific impact of OT SI treatment on body functions and academic functions for children with LD’s. • OT is an essential part of an interdisciplinary assessment and treatment for clients with LD’s, but more empirical data is needed.

  36. Thank You Questions or Comments? www.TheMorrisCenter.com

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