Yunel's OT Case Study
Aimee Doyle, OTD, OTR/L, explains how taking a child-led approach to therapy has given Yunel a chance to set the pace and enjoy being a kid while he grows in his sensory integration, joint play skills, primitive reflexes, grasp, balance, core strength, and more in his Occupational Therapy sessions.
Velcro Fruits & Shape Sorter: Multi-Step Visual Directions & Reflex Integration
“For Yunel specifically, we work a lot on grasping and releasing items… We’re working on him being able to purposefully release something into a target. We’re working on hand-eye coordination and also on inhibiting that [early developmental grasp] reflex, so that when he starts writing… he can use functional grasp on different utensils.”
The child-led aspects of therapy allow the child to choose the activity, and the clinician provides a rich environment for them to explore and adapts the activities to target their goals. Although he is not even aware that he is learning and growing, Yunel is making progress in important skills because he is motivated to play with the things that catch his interest. In this example, Aimee adapts his play with the velcro fruit and the shape sorter to include skills work like following visual directions, following multi-step directions, and integrating an early childhood reflex (grasping tightly) to make room for the more complex development that comes after reflexes are integrated, such as learning to color or write someday.
Scooter Track: Child-led Therapy Technique
Therapist : I see you!
Do you want me to move the soft mat?
Do you want to crash into it?
Yunel was uncertain about the scooter track at first. He began by noticing it, examining it, and then moved into tentatively exploring it by pushing the scooter back and forth on the track. Eventually, he gained confidence from being able to spend this time exploring and decided to sit on it himself and ride the scooter down the track. Aimee allowed him to not only choose the activities he was interested in, but also the depth at which he was ready to engage in them. She let him set the pace, allowed him to push the scooter, and gave him the encouragement and support he needed to overcome his apprehensions and become ready to ride the scooter himself.
Because Aimee allowed him to lead, he developed enough comfort in this session to work on his goals: being able to tolerate rocky movement on an uneven surface, practicing engaging his core to stabilize himself, and integrating many of his senses at once.
If she had chosen the activity, he may not have been as interested or engaged, which would have decreased his motivation and willingness to work through the effortful process of gaining new skills. When a child is highly motivated to do an activity that they’ve chosen, building the new skills necessary to do so will not feel nearly as arduous.
If she had pushed him beyond his pace, he may have become less willing to engage. If she had “helped” him too much and cut his process short by picking him up and sending him down the track on the scooter, he would not have been able to build the same comfort level, confidence, and independent skill mastery.
Swing: Taking a Break, Resetting, & Still Targeting Core Goals
“Incorporating breaks for kids, especially younger kids, is really important when we have a longer appointment time… We don’t want to wear them out, and we still want their full engagement while also making good use of the time that we’re together.”
Yunel needed some linear motion to help reset and calm his system. While Aimee let him choose the activity, and let him have the break he needed, she was still continuing to add in some core stability practice by changing the speed of the swing. She helped to stabilize him as needed by keeping her hand on his back, but he still had to make his own postural adjustments as the speed of the swing changed, causing him to continue working on the core engagement that he is working on, while taking a break from his other goals and getting a “reset” for his system.
Yunel’s Progress
During his time with Ms. Aimee, Yunel has grown so much through her skilled support for his explorations! He has gone from not engaging at all in joint play to spontaneously sitting with her and bringing toys to Aimee to play with together. Previously, he was not able to release his grasp in order to let go of a toy for the whole session, experiencing intensely distressing emotions and a meltdown if he was encouraged or helped to release it. Now, Yunel is able to engage more flexibly and with more enjoyment in the activities of his choice, as Aimee has worked with him on integrating his early grasp reflex, so that he can now successfully and confidently grasp and release items with ease, even letting go of them to give them to someone else without experiencing distress or difficulty from the leftover early reflex. We are so excited to see how he continues to explore and engage with his world, gaining more confidence and mastery as he goes!