Lisa is a delightful nine-year-old girl. Her doctor referred her to a private practice occupational therapy service after a psychoeducational assessment revealed a non-verbal learning disability. An occupational therapy assessment was carried out which consisted of two one-hour sessions at Lisa’s home followed by a feedback session with her parents to discuss the results of the assessment. During the assessment, the therapist had Lisa complete a variety of activities to examine her coordination, gross and fine motor abilities, and sensory and visual perceptual skills. For example, Lisa copied designs that increased in difficulty, provided handwriting and printing samples, and tried to identify similarities in pictures that had been rotated or changed in size. She also attempted to cut along lines with scissors, ball throwing, balancing and standing on one foot. During the assessment, the therapist also asked Lisa’s parents about her developmental history, any school issues or current concerns and received copies of other assessments already performed. The information gained from the assessment and from the family suggested that Lisa might have Developmental Coordination Disorder (DCD). During the follow-up session with the parents, the therapist went over the written report and recommendations. In this situation, ongoing occupational therapy was suggested to address areas of concern.
With the consent of the parents, an intervention plan was agreed to which consisted of 12 individual weekly sessions. The treatment approach chosen was Cognitive Orientation to Occupational Performance (or CO-OP). This is an occupational therapy approach that focuses on teaching the child and family how to use cognitive strategies to improve performance of tasks that are a problem for the child on a daily basis. A key component of the CO-OP process is that the child chooses the goals. Lisa wanted to work on learning to skip rope, to ride a bike and to improve her handwriting. Before treatment started, Lisa was videotaped doing each of these activities. She was only able to skip one revolution, could sit on the bike but not move the pedals, and her cursive writing was slow with many errors in letter formation.
The intervention started by introducing Lisa to a global problem solving strategy – Goal/Plan/Do/Check. Lisa learned how to apply this strategy to each task. For example, in skipping, Lisa realized that her arms were stopping after one revolution of the rope and that was keeping her from doing more revolutions. Her goal was to improve her skipping, her plan was to keep her arms moving in a circle. She was able to do her plan and finished by checking whether her plan worked. In addition to using this global strategy, Lisa learned strategies that were unique to the tasks she had chosen. For bike riding she learned that she needed to have her feet and her hands in particular positions for the best result and also that she needed to keep her legs turning quickly to maintain her balance.
A key component of this approach is that children are encouraged to discover these new strategies for themselves and are guided by the therapist in this active exploration. Each of the sessions involved having Lisa work on her three chosen activities. The global strategy and the task-specific strategies were explained to Lisa’s parents, who helped Lisa to use the strategies in other situations from week to week. At the end of the 12 sessions, Lisa was videotaped completing each of her three chosen activities. She was able to skip over 60 revolutions and had begun to experiment with double Dutch skipping as well. The skipping activity was particularly important to Lisa because at school, her class was participating in the fundraising event Jump Rope for Heart and, for the first time, she was able to join in with the rest of her friends. Lisa was able to ride her bike to the park and back, starting and stopping completely on her own. This was very important to her because at her age all of her friends could ride their bikes. Her handwriting had improved in speed and accuracy, which was helpful because her teacher was then able to read her writing and she was able to finish writing tasks in time. The therapist completed the treatment by providing the family with a summary of her progress and suggesting ways that the family could continue to work on other areas of difficulty.
Deborah Cameron, PhD., OT Reg. (Ont.) , in practice for 31 years, currently Assistant Professor, Dept of Occupational Science and Occupational Therapy, U of T, and partner in Reach Therapy Services, can be reached at firstname.lastname@example.org
This article first appeared in the September/ October 2002 issue of Occupational Therapy Now magazine published by the Canadian Association of Occupational Therapists. Reviewed July 2010.