Content Analysis

Children's Special Services, LLC, is owned by Susan Orloff, OTR/L, FAOTA.  Her basement is her clinic, and a loft next to the attic is her office.  Susan uses many different frames of reference as appropriate for her clients, and among the two that I believe she uses most often are a Frame of Reference for Visual Perception and a Sensory Integration Frame of Reference.  The majority of her clients have learning disabilities that have impacted their lives in various ways, including socio-emotionally, and Susan skillfully treats the "whole child" during their 1-hour weekly treatment sessions. 

Over the course of Fieldwork I with Susan, I learned some concepts for the first time, but I was also able to refine and better understand many things that I learned in class.  I feel much more comfortable about the OT's role in treating children with learning disabilities, visual perception issues, handwriting problems, and immature reflexes. 

My 3-week Pediatric OT Fieldwork I rotation is done, and I still find myself processing everything that I encountered.  Some might say that they found that they "knew more than they thought they knew" while at Fieldwork, but I found myself on the complete opposite end of the spectrum.  My fieldwork supervisor, Susan, has nearly 40 years of experience, and she is incredibly intuitive and smart.  My knowledge paled in comparison to hers, and I felt incredibly inexperienced and ignorant at times.  Fortunately, she is eager to spread her knowledge to OT and OTA students who wish to learn, and while I still feel like I have SO much more to learn to get to her level of expertise, I am incredibly grateful to have had the opportunity to learn under such an incredible professional and person. 

Learning Disabilities: Carly

Please click on the links below to access the documents.  You will have to sign in to your Google account, as it is linked through Google Drive.

Educational Material
Home Program

Well said, Tyler.

The following piece was written by Tyler Carawan, an OTA student who was also doing his Fieldwork with Susan Orloff while I was there.  It was written in conjunction with a chart that listed each child served at the clinic along with the goals of their treatment.
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Improving on each of these deficits for each of these children

will have numerous social and emotional implications. Though

each child experiences his world differently, in general being

able to improve on an existing skill or develop a new skill

will have an enormous social and emotional impact throughout

the child's life.

During these early school years, OT will allow for increased

performance and success in the classroom by providing the

skills that the child needs to keep up with his academic demands.

This in turn will build confidence and many other positive feelings

in the child, as well as increasing his tolerance to criticism

and corrective remarks so that educators can steer the

child in the proper academic direction.

Success in the classroom is only a part of the puzzle. Another

piece is that many of these skills can be carried over into

sports, social activities, time spent on the playground, and

eventually these skills will be adapted by the child and carried

over into higher education, into business, and into adult

relationships that they will all have.

It is so very important to work with these children and their

learning troubles now, so that we can either remediate the

issue, or help them to learn a compensatory strategy to

increase their success. The way that they feel about learning

today, the way that they feel in front of their peers today,

and their success in the classroom today will most assuredly

define who they are as they grow, as they learn, whether they

decide to persue secondary education, how they handle the

variety or relationships in their life, and whether or not they

will be successful productive members of the work force and

successful productive members of our society.

Feeling confident about learning, feeling good about who one

is as a person, and growing upon those feelings is so very

important, and in feeling good, they will have the confidence

that they need to succeed.

                                                                   -Tyler Carawan

Crossing the Midline

I never realized how big of a deal it is to be skilled in "crossing the midline" until fieldwork.  In case you're interested, here's a link to a website that helped me understand a few things:
http://www.ot-mom-learning-activities.com/crossing-the-midline.html

A Frame of Reference for Visual Perception

It appears that Susan treats many of her clients using this frame of reference because many of her clients (who happen to have learning disabilities) test low on assessments of visual perceptual skills.  

A Frame of Reference for Visual Perception is generally used to help children who have trouble in areas of occupation because their systems are unable to effectively translate and use visual sensory information (Schneck, 2010).  Susan sees many children who have trouble with scanning, form constancy, figure ground, visual discrimination, visual memory, depth perception, position in space, and visual motor integration. 

Modalities & Treatment Techniques

 

 

Battleship:  This is an "old" board game that requires children to visually scan the columns and rows in order to try to "sink" their opponent's ships.  It also uses visual motor integration skills when children have to place pegs into small spaces.  There are other great board games in Susan's clinic that she uses for visual perceptual improvement.  Susan's shelf of games are in the photos below.

 

 

 

Stippling:  This craft activity resembles sewing.  Stippling is a term often heard by quilters, but Susan has some clients sew with needle and thread in a special way around a card stock photo.  The client whose work is shown on the bulletin board with the football player (photo below) had difficulty with figure-ground, and Susan said that stippling would help him work on that skill.

 

 

 

 

Cutting & Handwriting: Susan has children color and cut out pictures, and she created a handwriting program called Write Incredibly Now (WIN) that she uses with many of her clients.  This works on several visual perceptual skills, including visual-motor integration. WIN uses colors and basic shapes to teach children how to write legibly in cursive in 12 hour-long sessions.  There is currently no literature on the WIN program.

 

I have seen Susan use several tests of visual perception during evaluations, including:

The Jordan Left-Right Reversal Test

The Beery VMI

Motor-Free Visual Perception Test

Wide Range Assessment of Visual Motor Abilities

 

 

References

 

Schneck, C. M. (2010). A frame of reference for visual perception. In P. Kramer, & J. Hinojosa (Eds.), Frames of Reference for Pediatric Occupational Therapy. Baltimore, MD:  Lippincott Williams & Wilkins.

 



A Sensory Integration Frame of Reference

Susan sees a lot of children who have learning disabilities.  She has a lot of OT experience, so she feels comfortable using several frames of references with her clients. 

A Frame of Reference for Sensory Integration

Susan, like our department chair, Dr. Ricardo Carrasco, was trained for using the sensory integration frame of reference by Jean Ayres herself.  She often tells me about Jean Ayres and quotes her a lot.

This frame of reference (FOR) demonstrates how the senses work together to produce movements and behaviors, and if there is a problem with any of the senses or their ability to work together (such as with learning disabilities), then childhood occupation can be impaired (Schaaf, Schoen, Roley, Lane, Koomar, & Mae-Benson, 2010)

A small study by May-Benson & Koomar (2010) suggests that Sensory Integration is an effective therapy technique for many childhood issues, including (but not limited to) attention, behavioral, social, play, and reading skills.  However, a Google Scholar and EBSCO search yielded no results for the specific modalities that are used in the clinic at Children's Special Services, LLC in conjunction with specific learning disabilities.

Modalities and Interventions using the Sensory Integration FOR

Vestibulator: If you look at the photo below, you will see this item, which resembles a swing set.  Different swings, like bolsters, platforms, or trapeze bars (pictured in center of photo in red, blue, and tan) can attach to the top of the Vestibulator depending on the activity desired.  The entire device can be moved around the clinic as needed. 

Susan uses different swings on the Vestibulator to either check for (during an evaluation) or provoke (during treatment) a vestibular response when the child is lacking.  On another occasion, a child sat on the platform swing, and Susan swung him to check for stability during movement.  Susan also has attached a net swing to the Vestibulator during treatment to work on motor planning (ex. getting in and out of the net).




Zip Line:  If you look at the long light in the photo below and move your eyes to the center of that light, you will barely see a rope that extends across the ceiling.  This rope extends from one corner of the room to the opposite corner.  The children climb onto a chair then wrap their legs and arms around a 5-foot rope that has knots (to help with slipping).  Then then lift their legs from the chair and "zip" through the air along the zip line and have to land on their knees with their hands up in the air.  The landing is fortunately not cement, like shown.  It is a large, soft spongy mat.  The purpose of using the zip line in sensory integration is for proprioceptive and vestibular input, but Susan also uses it to work on timing (when to land), on muscle strength, and on teaching children to not be so fearful to try new things.

 

Ramp & Scooter Board: (Seen in photo below) Children can get on the scooter board, roll down the ramp, and crash into a mat.  Susan uses this for children who crave movement, who need to work on stability during movement, and who are fearful to try new things.

 

 

 

Climbing wall: This can be seen in the photo below along the back wall.  Susan uses this to help children combine visual, tactile, proprioceptive, and vestibular movement as they plan motor movements to climb the wall.  The activity can be made more challenging by telling the child to "only use the yellow" markers or "only use the blue."  The climbing wall is also used to encourage children to cross midline during movement, to increase muscle strength, and to encourage children to try new and challenging things.

 

 

 

 

 

References

 

May-Benson, T. A., & Koomar, J. A. (2010). Systematic review of the research evidence examining the effectiveness of interventions using a sensory integrative approach for children. The American Journal of Occupational Therapy, 64(3), 403-414.

 

Schaaf, R. C., Schoen, S. A., Roley, S. S., Lane, S. J., Koomar, J., & Mae-Benson, T. A. (2010). A frame of reference for sensory integration. In P. Kramer, & J. Hinojosa (Eds.), Frames of Reference for Pediatric Occupational Therapy. Baltimore, MD:  Lippincott Williams & Wilkins.