Practical Cases Flashcards
- Devan has a slight speech delay, hand/eye coordination difficulties, and difficulty with handwriting activities in his first grade classroom. He receives speech therapy outside his typical classroom activities. In class, Devan is observed to be quieter than his fellow peers. During writing assignments, he prefers to stand and reports he dislikes handwriting. His teacher reports that he frequently rushes through handwritten activities. Devan demonstrates significantly better legibility during one-on-one sessions over in class handwriting. During movement and song breaks, Devan appears less engaged than his fellow peers, stating, “I don’t dance”. His teacher reports that he doesn’t like to be touched and is observed to have sensory avoidant behaviors at time, particularly with tactile and auditory sensitivity.
Needs (2): visual motor, sensory
Formal Evaluation (2): the BOT, Sensory profile
Informal Evaluation: Queensbury and a handwriting sample.
Preparation: Proprioception - heavy work, obstacle course, sensory bin, listening programs - advanced brain tech, integrated listening, therapuetic listening. As we walk from classroom to OT room I will be weighted totebag for the child to carry or a flexbar to facilitate heavy work. We can pretend to be superhero’s and make sure all the wall in the building are straight - wall pushes. When we enter the classroom we can do more calming activities like simple stretches, alphabet yoga. we can end with legs up the wall - deep belly breaths.
Swing - belly down, slightly upside down, using hands to push them in linear movements - it’s organizing to the sensory system.
Intervention 1: sensory bin writing exercise. If the student won’t tolerate that we can do sky writing. We can work on a simple sentence. their name,
Intervention 2: writing. with a child chosen muscial instrument, bells, xylophone, tibetan singing bowl, small drum, The student will write a word, after every word they will make a sound with the instrument and take 3 deep breaths. forcing the student to start and stop.
Data:
Home/classroom modification:
Goal:
Objective:
- Noah is a 5 and 1/2-year-old boy who wears glasses. He is a smart little boy, but cannot sit still. His teacher describes him as a child who constantly shifts position, tilting his head and, despite abilities in motor skills, cannot use them appropriately in the classroom. His writing and other performance skills in the classroom are always a mess. He is not bothered by his performance, though his activity level and performance greatly distracts the other children. His personal space requires firm boundaries and he is constantly told to keep his belongings on his own spot.
Needs (2): self regulation, fine motor
Formal Evaluation (2): Beery because it will get teh visual motor bit and it’s quick, sensory profile
Informal Evaluation: schoodles, sentence writing sample
Preparation: VESTIBULAR THAN PROPRIOCEPTIONS
Swing, linear movement with a giant exercise ball bump. JUMP AND CRASHbelly down, hands pushing to complete a puzzle
Intervention 1: self regulatory skills - deep belly breathing, figure 8’s, wall pushes, legs up the wall. Talkk about how does our engine run. and strategies for getting back to calm cool and collected.
Intervention 2: sensory bin with letters hidden inside. take out the letter and write it down.
Data:
Home/classroom modification:
Goal:
Objective:
- Mary is a 1st grade student who has a diagnosis of Down syndrome. She demonstrates the ability to write her name independently with the use of a proper tripod grasp. She is able to assume a thumbs up grasp on scissors and is able to cut within ¼” of a straight line. She has difficulty cutting squares, circles and other complex shapes. Mary will color in pictures with minimal attention to boundaries of the picture and often using only one color. At times, Mary can have out of seat behaviors including getting up to move around the room, refusing to complete her work and drawing lines down her paper through her assigned work.
Needs (2): sensory,
Formal Evaluation (2): SFA, MILLER Fun, sensory profile.
Informal Evaluation: SI screen, handwriting sample
Preparation: Dance party trampoline. To wake them, get them moving and increase motivation
Intervention 1: obstacle course with a puzzle. they can walk across some stepping stones or a balance beam, crawl through a tunnel. swing with a puzzle that deals with shapes. asking them to grap the
Intervention 2: Using wiki stix to outline a shape, circle, square, triangle. the coloring inside the shape. leave one row of shapes with and one row without. Ask them to do the wiki six ones first and then the shapes without out
Data: coloring in the lines
Home/classroom modification: balance ball chair for core stability, not all day though. Wiki stix,
Goal:
Objective:
- Chad is a bright 3rd grade boy who demonstrates a high level of intelligence but increased frustration if he is not correct. He is easily distracted by peers in the classroom during periods of seated work. Chad has difficulty working in groups and is often seen as “bossy” by his peers. His teacher indicates that his handwriting is very difficult to read and is often illegible. When asked to verbally state his answers, he always has the correct answer. He shows intense concentration when he is asked to complete activities but frequently forgets everything he needs to do to complete an assignment, and does not refer back to written directions.
Needs (2): Handwriting legibility, cognition/ executive function / ADHD
Formal Evaluation (2): BOT, Sensory profile, GOAL
Informal Evaluation: handwriting sample. Queensbury, SI
Group session where turn taking, patience and social interaction is necessary.
Preparation: swing or proprioective activity to calm the nervous system. Legs up the wall, block under sacrum weight on feet,
Intervention 1: Introduce goal plan do check and do a simple in session goal that addresses his handwriting challenges, maybe it’s alignment or spacing. do it and have them check their work.
Intervention 2: Play a game that works on exectuve function, turn taking and social interactions.
Data:
Home/classroom modification:
Goal:
Objective:
- Rocco is a kind and polite kindergarten student; he is 5 years 7 months old. Rocco has had no preschool experience, does not know his letters or numbers and is struggling with all aspects of his kindergarten curriculum. He is an active boy and will often move around the room with no clear direction on the purpose he is out of his seat. Rocco demonstrates an immature grasp on a writing utensil. He does not cut on lines, colors his papers in one color and over the lines, and cannot write his name legibly. He is a great friend to his peers, and would prefer to talk or play with them rather than do his own work.
Needs (2): fine motor, sensory
Formal Evaluation (2): sensory profile or BRIEF, Miller fun - exec fun, motor and visual perceptual. BOT - motor and visual motor
Informal Evaluation: SI tool - handwritng sample
Preparation: animal walks, scooter board, alphabet puzzle. swing, belly down using hands to
Intervention 1: Play alphabet jenga or site word jenga. everyone writes that letter on the piece.
Intervention 2: color by letter pages. working on grasp and staying in the lines.
Data:
Home/classroom modification:
Goal:
Objective:
- Jaya is a first grade student who displays behaviors in the classroom that are disruptive to herself and the other students in the class. Jaya socializes frequently in her classroom and during classroom activities, when it isn’t the appropriate time for socialization. She likes to touch other children around her and she touches her own shirt or hair often. She is unable to stay seated appropriately in her chair during classroom activities without frequent verbal cueing and re-direction from her teacher; she tends to wander around and look at what the other children are doing. Her teacher also mentions that at times Jaya seems to stare absently off. Jaya has difficulty initiating and terminating a task on her own without verbal cues, and she tends to become distracted easily by her surroundings. Her ability to maintain her attention declines after participating in an activity for about 5 minutes. She often has difficulty following directions with multi-step tasks. Jaya’s teacher also commented on her handwriting and her incorrect grasp, use of upper case letters, when she should be using lower case letters and generally incomplete work. Gym and recess are her favorite times of day.
Needs (2): sensory, motor planning
Formal Evaluation (2): sensory profile, WRAVMA
Informal Evaluation: handwriting sample
Preparation: Proprioception - wall pushes, walking through a tunnel, swing with linear movements and a bump,
Intervention 1: sensory bin with
Intervention 2:
Data:
Home/classroom modification:
Goal:
Objective:
- Liam is a five year, nine-month-old boy with a diagnosis of Down syndrome. Liam is very friendly and gets along well with his classmates in his kindergarten classroom. He is curious about his environment and will point to items and ask, “What’s that?” He often a self-initiates interaction with his peers and readily imitates others. He has developed a ‘school routine’ but does not do well with variations from this routine. He presents with challenging behaviors, including tantrums and removing his shoes, when presented with new skills and any change to his environment or routine. Liam struggles with transitions to other activities and participating in unstructured play. He has a short attention span and displays decreased attention. He is hesitant to perform self-care activities necessary for school, such as putting on his coat, and frequently requests an adult’s assistance. Liam also presents with weakness in his hands, leading to poor and inaccurate cutting, writing, and coloring skills. He holds a crayon with a gross grasp and can copy a circle and lines. Liam has difficulty understanding directions and often ignores requests from teachers and peers.
Needs (2): strength, sensory
Formal Evaluation (2):
Informal Evaluation:
Preparation:
Intervention 1:
Intervention 2:
Data:
Home/classroom modification:
Goal:
Objective:
- Six-year-old Anthony is in a first grade classroom of 27 students. Anthony is unable to write his name and has difficulty with letter recognition. Anthony is quiet, often observing his busy surroundings. Anthony has and continues to attempt all classroom activities. Anthony plays with his classmates if they join him in the activity he has chosen to play. Anthony appears quiet and withdrawn in large groups. Anthony appears clumsy when moving around the classroom, often bumping into objects and peers in the room. Anthony’s responses are often impulsive, hindering him from him properly responding and following directions. When asked to print his name, Anthony wrote the letter ‘A’ and circles until he ran out of room on the page. Anthony has difficulty following sequenced directions. Anthony’s speech is difficult to understand.
Needs (2): motor planning, handwriting literacy
Formal Evaluation (2): WRAVMA, sensory profile
Informal Evaluation: Queensbury
Preparation: balance - stepping stones, balance beam, exercise ball or swing - spinning, using a metronome jumping
Intervention 1: sensory alphabet exercise - tracing
Intervention 2: goal plan do check - writing name.
Data:
Home/classroom modification:
Goal:
Objective:
- Jordan is a very bright 8-year-old in third grade. The teacher has referred him to OT because he is having increasing difficulty remaining in his seat in the classroom. He is irritated by the sound of the pencil sharpener in the classroom and by all of the people talking in the hallway outside the classroom. He has recently begun to fall behind in seatwork that needs to be completed independently. He complains that it is too noisy in the classroom for him to finish. He has also pushed children away from him when they get too close to him in line. Jordan has ongoing difficulty with handwriting and he has not been able to master cursive. As a result, he does the minimum amount of written work to get by and this is beginning to have an adverse impact on his grades. His parents have scheduled a meeting to discuss what to do to make him successful.
Needs (2):
Formal Evaluation (2):
Informal Evaluation:
Preparation:
Intervention 1:
Intervention 2:
Data:
Home/classroom modification:
Goal:
Objective:
- Daniel is an energetic and friendly 8-year-old boy who recently moved to a new school district in the fall. He is mainstreamed in a 3rd grade classroom. Daniel has made great progress this year in the area of social/play skills and is a favorite among his peers. In grasping, Daniel currently switches between a static tripod grasp and a radial digital grasp during writing tasks. Dan is able to draw lines and a circle. He had difficulty drawing a cross and square. He is able to print his name but some of the letters are illegible. It is very difficult for him to control his hands for precise writing tasks and due to his inability to attend for more than a few minutes, he often rushes making the writing illegible. When he attempts to print new letters, he quickly becomes frustrated and gives up without attempting any different strategies. He has been more willing to attempt writing tasks, and does best when given very explicit verbal cues as well as a visual demonstration. His cutting skills have improved dramatically, though he often needs verbal cues to keep his eyes on the task especially in a group setting with distractions.
Needs (2):
Formal Evaluation (2):
Informal Evaluation:
Preparation:
Intervention 1:
Intervention 2:
Data:
Home/classroom modification:
Goal:
Objective:
- Philip is a very verbal and imaginative Kindergarten student. He is charismatic and likes dramatic play, sometimes dressing up in hats to be policemen, firemen, or superman. Philip has difficulties with social skills. He plays well with peers as long as the play goes his way, but when it doesn’t, he will bully the other children and say, “Nobody can touch any of these toys!” He often misconstrues social signals (e.g., confusing accidental and purposeful touching) and becomes aggressive with other children. He is anxious about making friends. Philip is a hypersensitive child. If he gets hurt, he overreacts strongly, screaming at his parents or other adults not to touch him. He hates haircuts, avoids new food textures, and prefers long-sleeved garments and pants even in warm weather. He is sensitive to loud noises and seems to have difficulty focusing at school, going from one thing to the next. When not engaged in an activity, he often zones out watching TV. Philip is fearful of riding a bicycle due to unexpected movement, fear of falling, and dislikes trying new movement activities. He is a perfectionist when completing written work in the classroom. He frequently does not finish all of his work. Often his worksheets and Writer’s Workshop papers have holes in them from the frequent erasures. He has had great difficulty mastering printed handwriting and this has resulted in more frequent outbursts in school.
Needs (2): sensory, motor planning
Formal Evaluation (2): sensory profile, Miller fun
Informal Evaluation: test of playfulness
Preparation: Superhero, give him a mission, hold up the walls, crawl through a tunnel and save the kittens
proprioception -
Intervention 1: sensory writing exercise
Intervention 2:
Data:
Home/classroom modification:
Goal:
Objective:
- Eight-year-old Olivia is in a regular school classroom placement receiving related services two times a week from an OT. Olivia demonstrates tactile defensiveness, poor bilateral coordination, decreased trunk rotation and poor balance and equilibrium reactions. Her parents report that she used to love going to t-ball and playing with her friends but now that she is in Little League she seems to be overly intimidated by the pitching and can’t seem to get the idea of running to catch a ball. The physical education teacher reports that Olivia is becoming a behavior problem in PE classes, frequently pushing and shoving other children. Her third-grade teacher is already talking about having Olivia repeat 3rd grade because her class work is sloppy and incomplete.
Needs (2):
Formal Evaluation (2):
Informal Evaluation:
Preparation:
Intervention 1:
Intervention 2:
Data:
Home/classroom modification:
Goal:
Objective:
- Jace, 6 years old, is in a K-2 special education classroom. Jace is given sensory breaks more often than others due to “high energy.” Jace presents with difficulty holding his pencil the right way, breaks crayons and has difficulty holding scissors. He appears weak and gets frustrated or leaves the activity when using small items. In the classroom, Jace is very easily distracted and has trouble focusing on tasks that he is asked to do. He is also very sensory-seeking, and is often seen bumping into others, rolling around on the floor, or running around. Jace is not able to mainstream for specials (gym, art or music) due to his behaviors.
Needs (2):
Formal Evaluation (2):
Informal Evaluation:
Preparation:
Intervention 1:
Intervention 2:
Data:
Home/classroom modification:
Goal:
Objective:
- Andrew, diagnosed with ASD, is a 7 year, 7-month-old boy who attends class in a self-contained K-2 classroom. Andrew demonstrates difficulty in transitions despite his pleasant disposition. Andrew’s handwriting skills are poor for his grade, as he is not able to construct sentences without copying visual prompts or to follow prompts for free writing. Andrew is verbal; however, he often only speaks in one word statements, usually when prompted, or repeats what is being said to him. Andrew does not play or interact with his peers though he is respectful of their personal space. During group activities, Andrew needs reminders to stay seated and is observed scripting and stimming rather than being present for the lesson.
Needs (2):
Formal Evaluation (2):
Informal Evaluation:
Preparation:
Intervention 1:
Intervention 2:
Data:
Home/classroom modification:
Goal:
Objective:
- Willem is in a regular first grade classroom; he does not have an IEP but is a part of RtI, as he is at risk for falling behind in English Language Arts (ELA). Willem is currently on Tier III of RtI. Willem struggles with writing; including correct use of uppercase and lowercase letters, word spacing and proper punctuation at the end of the sentence. Willem struggles to complete assignments, or if they are completed, added instruction is needed. Sometimes, Willem struggles to maintain attention while in the classroom and can get distracted causing him not complete work. Willem is falling below expectations of the first-grade level despite instructional attempts in the classroom.
Needs (2): sensory and handwriting
Formal Evaluation (2): MVPT, miller fun
Informal Evaluation: handwriting sample - copy a sentence
Preparation: flexbar, wall pushes, crawling through a tunnel, animal walks, scooter
Intervention 1: sensory writing activity
Intervention 2: sentence writing game.
Data:
Home/classroom modification:
Goal:
Objective:
- Kimmy is in a first-grade special education classroom and struggles with handwriting and social skills. She is generally very quiet, and often needs additional support from aides in the classroom. She has a hard time maintaining attention to tasks and subjects that are difficult for her or that she is uninterested in. She slouches and fidgets with her glasses, writing utensils and other items on her desk or near her during English Language Arts (ELA) and math. She is right handed and uses the left arm to stabilize the paper about half of the time. She is frequently observed resting her head on her desk during lessons. The teacher reports that Kimmy has difficulty transitioning: other classmates “bother” her. She gets frustrated by the requested changes, cannot let go of the situation and move on. Kimmy receives speech therapy for communication and is in a social skills group for coping skills.
Needs (2): handwriting, sensory
Formal Evaluation (2): Miller Fun, sensory profile
Informal Evaluation: Queensbury or writing sample
Preparation: clear expectation, First then, token economy maybe a behavior chart. I would use every minute counts character strength. vestibular input, postural support, balance ball, bump and crash, proprioception wall pushes
Intervention 1: air writing, sensory bin writing, playdough writing, shaving cream
Intervention 2: jenga with site words, sentence building game
Data:
Home/classroom modification:
Goal:
Objective:
- Seven-year-old Asher is in a 2nd grade classroom where he has demonstrated a left-sided neglect, and an inability to cross body midline with either hand. He uses a gross palmar grasp on a pencil with his right hand, and can have poor balance and coordination in the classroom. His teacher reports that Asher seems like a very bright little boy but is unable to master the transition from printing (manuscript) to cursive. Asher is also struggling with math. On the playground, the aide reports that she is concerned about his safety. Twice this year Asher has walked in front of a swing and been knocked to the ground.
Needs (2):
Formal Evaluation (2):
Informal Evaluation:
Preparation:
Intervention 1:
Intervention 2:
Data:
Home/classroom modification:
Goal:
Objective:
- Nine-year-old Simon is in a regular school classroom placement. Simon demonstrates decreased postural tone in his trunk, poor trunk rotation, poor bilateral coordination, excessive use of postural fixations during gross movement, poor hand coordination during writing and decreased endurance. His teacher reports that Simon frequently complains about his hand being tired. She is very frustrated with his performance because his achievement tests scores indicate he is functioning several grades above his current fourth grade placement. Simon holds a pencil using a static tripod grip and his cursive writing is produced very slowly. Simon has difficulty staying on lines and spacing between letters and words is poor.
Needs (2):
Formal Evaluation (2):
Informal Evaluation:
Preparation:
Intervention 1:
Intervention 2:
Data:
Home/classroom modification:
Goal:
Objective:
- Ryan is a bright 9-year-old who brags continuously about his athletic prowess. However, when presented with a new motor task, he attempts to avoid the activity by labeling it dumb or boring. He frequently attempts to manipulate the therapist by changing the activity to a more familiar one or by talking about how well he would do the activity until there is no time left to give it a try. His teacher reports that his cursive handwriting is illegible and that he reverts to printing information, which is very slow. She has encouraged him to use the classroom computer but he complains that it is too difficult to learn keyboarding and that he would rather play computer games with a joystick.
Needs (2): motor planning, keyboarding
Formal Evaluation (2): BOT, GOAL
Informal Evaluation: SI screen, occupational profile
Preparation:
Intervention 1:
Intervention 2:
Data:
Home/classroom modification:
Goal:
Objective:
- Brent is a bright, articulate 7-year-old (second grade) with significant behavior problems. He seems to work very hard, even at things that should be fun. He seems constantly frustrated and angry. When things don’t go as he anticipates, he becomes extremely upset—even violent. Brent broke his nose while playing t-ball last year. He told his mom, “I moved behind the ball like the coach said but I forgot to put up my glove.” He works very hard at written assignments, often writing and erasing so hard that he leaves holes in his paper. He has difficulty organizing tasks and often appears clumsy and awkward.
Needs (2): motor planning, self regulation
Formal Evaluation (2): sensory profile, Miller fun
Informal Evaluation: Queensbury
Preparation: hallway, flexbar, superhero, behabior chart, first this then, clear Sensory regulation - swinging, bump and crash, proprioception legs up wall, deep breathing.
Intervention 1: writing in a sensory bin, play with varying strength of writing.
Intervention 2: 3 part - imagine, draw, write
Data:
Home/classroom modification:
Goal:
Objective:
- Jennifer is a 7-year-old second grade student who appears to be struggling in all areas of school. Her teachers describe her as slow and lethargic. Her speech is labored and her tongue movement is awkward. Her handwriting is large and jerky. She has difficulty with staying on the lines and holds her pencil in a radial palmer grasp when drawing, coloring or printing. As she performs jumping jacks in PE, her arms and legs do not move smoothly. She appears to be stuck to the floor when trying to jump. She never attempts to play on any of the climbing toys on the playground and is fearful of swinging.
Needs (2):
Formal Evaluation (2):
Informal Evaluation:
Preparation:
Intervention 1:
Intervention 2:
Data:
Home/classroom modification:
Goal:
Objective:
- Billy is an 8-year-old student in a general education classroom environment. He lives at home with his parent and 3 older siblings. Billy’s family and educational team requested an occupational therapy evaluation due to his difficulty with writing, attention, and peer relationships. Billy has above-average academic ability. He does not interact with his peers. He expressed concerns that as the demands of school increased, he was going to fall further and further behind. He has poor use of his hands for any tasks even opening his lunch. Billy’s writing is illegible. His parents, who are both physicians, are very concerned that he has no friends. His comprehension of simple verbal instructions is difficult. He has unusual habits and rituals and poorly established patterns of activity such as getting ready to go to bed or mealtimes.
Needs (2):
Formal Evaluation (2):
Informal Evaluation:
Preparation:
Intervention 1:
Intervention 2:
Data:
Home/classroom modification:
Goal:
Objective:
- Elizabeth is a 6-year-old in first grade. She struggles with the amount of work that is expected. Math is very hard for her, as is keeping pace during writing tasks. Elizabeth is very lethargic, preferring to play quietly indoors rather than outside on the playground during recess. She has recently begun to wear glasses, though she still struggles with all work in the classroom. Her written work ends up on the right-hand side of the page, as she never returns to the left margin without cues. She is very bright, as she can tell the teacher all information verbally. Learning manuscript handwriting has been very hard for her, and she cannot seem to get the letters correctly on the paper. Elizabeth is an excellent singer, though she learns by ear rather than reading the words or music.
Needs (2):
Formal Evaluation (2):
Informal Evaluation:
Preparation:
Intervention 1:
Intervention 2:
Data:
Home/classroom modification:
Goal:
Objective:
- Seven-year-old Emmanuel is one of 30 students in his first-grade classroom. Emmanuel is consistently distracted and as a result misses directions given. Emmanuel is easily frustrated when working independently. Emmanuel is very active and constantly moving in his seat. He is easily distracted by other activities in the classroom, he is constantly telling other students to “be quiet and to leave him alone”. While working on writing, Emmanuel is constantly asked to stay on task and complete the worksheet. Emmanuel’s attitude during these activities is negative and, if an error was made, Emmanuel throws his writing utensil against the table and says “I can’t do this, I’m no good at this stuff”. Emmanuel is often the last student to complete the worksheet tasks and his writing is generally difficulty to read. Emmanuel’s favorite subjects in school are physical education, especially when basketball is being played, art class and computer time. Emmanuel enjoys art class when he has painting activities and feels he should have art more than one time a week.
Needs (2):
Formal Evaluation (2):
Informal Evaluation:
Preparation:
Intervention 1:
Intervention 2:
Data:
Home/classroom modification:
Goal:
Objective:
