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SLP Mommy of Apraxia: September Specialty Series: Ask an Occupational Therapist

Sunday, September 7, 2014

September Specialty Series: Ask an Occupational Therapist

Today I am excited to introduce Tonya from TherapyFunZone!  Thank you for agreeing to guest blog today Tonya!  Please tell us a little bit about yourself!

I am Tonya, and have been a pediatric Occupational Therapist for 23 years.  I have worked with a huge variety of kids and diagnoses in my career as an OT, and have worked in a clinic setting, inpatient acute, inpatient rehab, early intervention, and school district.  I have treated kids with spinal cord injuries, cerebral palsy, spina bifida, coordination problems, feeding problems, and autism.

I have seen a few acronyms for occupational therapy.  What's the difference between an OT and a COTA?

I am an OTR (Occupational Therapist, Registered), and also work with several COTAs, which are Certified Occupational Therapy Assistants.  They go through OT school and have specific training in treatment techniques.  They do not have training in evaluations, which OTRs do, but COTAs have lots of experience and training in activities and treatment techniques.  We work together to get the best treatment for the kids that we see.

The field of OT seems to cover so many areas.  What areas do you diagnose and treat in the pediatric population?

In essence, as an OT, we treat the problem areas and it isn’t as important what the underlying diagnosis is.  When I evaluate a child, I look at what activities and movements they can and can’t do, and why they can’t do it.  Occupational Therapy treats and helps modify tasks in order for you to be able to do and participate in the “occupations” of life.  These occupations in your day consist of being able to get dressed in the morning, feeding yourself, taking care of your needs such as grooming and hygiene, and for a child, they include playing and participating in school. 
Will you define apraxia as it relates to gross and fine motor skills and tell us, what is the appropriate term when describing gross and fine motor planning issues?  I’ve heard apraxia, dyspraxia, limb dyspraxia, DCD (developmental coordination disorder).  Are these the same thing, or are there differences?                                                 

One area that can limit kids is the area of Praxis.  Praxis is the ability to organize your movements to complete a specific task.  When using medical terminology, you add an A in front of a term to mean not there, and a dys in front of the word to mean difficulty with, so the word apraxia means the inability to organize those movements, and the word dyspraxia means difficulty organizing movements.  Many times when talking about praxia, these words are used in the same way, although they technically don’t mean exactly the same thing, but really, they are close enough in meaning that it is not a problem. 

Many people also use these terms to relate to the specific activity that the child has trouble with, such as speech apraxia, dressing apraxia, etc.  In my reports, I tend to just talk about motor planning as it is a more easily understood term rather than a medical term, and the definition is the same.

Another term out there is Developmental Coordination Disorder.  This is an actual medical diagnosis that has to come from a neurologist. This actual diagnosis was created in the 1990s to be used with kids that had these coordination problems but didn’t fit into any other established diagnosis.  Before that these kids were just labeled as clumsy and uncoordinated.  Some may have fallen into a category of mild cerebral palsy, but did not really fit there either.  
What are some early signs of motor delays in infants and toddlers and what should parents do if they suspect delays?

Motor planning problems is not an area that you can diagnose very early because all young children have to go through their developmental stages, and there is a wide range of normal development.  Every child is going to gain skills at a different pace, so you really do have to wait and see if the child will just develop a tiny bit later than you had hoped.  You also can’t expect a child to be able to do an activity if they have never had an opportunity to try and practice the activity.  For example, you can not consider a child delayed with the ability to cut with scissors if they have never been allowed to touch scissors before.  Here is a developmental guide for fine motor skills, which can give you an idea of what skills you would expect your child to be able to do next in their age level. 
What would you recommend parents focus on most to encourage motor skills at home?  I get packets of suggestions from the therapists, but find them so overwhelming at times.  

Many times, kids who have some coordination problems will benefit the most from individual sports types of activities such as gymnastics and karate, or lots of active outdoor play at the playground.  These sports let the kids practice motor movements in a typical kid environment, but the kids are just working to get better at the sport for themselves and not for a team (although team sports are great too).  Getting outside and playing in nature and experiencing a large variety of physical movements is the perfect therapy as well.  Slide down the slide upside down, hang on the monkey bars, crawl through mazes, climb trees, etc.

When working on developing skills at home, the best thing is to work movement and activities into your normal day and normal life.  Most of the time, therapists will give you a long list of activities to do, but that is because not every activity is going to work for everyone, so they give a list of things that you can pick from or that can trigger an idea of an activity that you may already do that is the same.  For example, squeezing sponges may be on a list for hand strengthening activities, so you can think “ah, great idea, I can just throw some sponges into the bath, and our therapy will be done during bath time”.   Our objective as therapists is not to make life more difficult for you, but to try to make life easier by giving lots of ideas so that one or two of those may be a perfect fit for your life. 

That’s what I love about your blog and facebook page Tonya!  You give activity ideas that are practical, and I feel like I can get motor work in every day just by incorporating your suggestions.  For my readers who don’t know, can you tell us a little bit about your blog?

I have a site called Therapy Fun Zone, where I post activities that target specific skill areas.  I think that if the therapy isn’t fun, then the kids won’t participate to the fullest.  When I first became an OT, I did not realize how much creativity is involved, which is my favorite part of being a therapist.  I enjoy thinking outside the box and problem solving to make a task easier or harder, depending on what is needed.

Thank you so much Tonya for being here today!  Please visit Tonya’s facebook page and blog for great tips and ideas!

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