Interviewed by Erika Goyer, Hand to Hold Family Support Navigator
Raising a kid with special health and developmental needs can seem daunting! Often, we come home from the NICU with a list of follow-up appointments to make, screenings to do and specialists to see. Each month Hand to Hold will talk to a different therapist, specialist or provider to learn more about them and what they do. This month we spoke with Rebecca Pokluda, MOTR/L, Clinic Director and Owner of KidWorks Therapy Services. She is a licensed Occupational Therapist in the State of Texas with several specialty certifications in pediatrics. She holds a Master’s of Science in Occupational Therapy from Texas Women’s University. Rebecca completed her Bachelor of Science degree in Kinesiology from the University of Texas at Austin. Rebecca is a member of the following associations: American Occupational Therapy Association, Texas Occupational Therapy Association, The Interdisciplinary Council on Developmental and Learning Disabilities, Sensory Processing Disorder Foundation and EEG Spectrum International for Neurofeedback Providers. KidWorks Therapy Services is also a member of Hand to Hold’s Early Intervention Coalition.
What is occupational therapy?
Occupational Therapy (OT) is a health profession that helps patients improve the way their nervous system functions. We help clients develop skills that will lead to success in everyday life including: motor, social, personal, academic and vocational pursuits. An OT is an allied health professional trained in the biological, physical, medical and behavioral sciences, including: neurology, anatomy, physiology, human development, kinesiology, orthopedics and psychology. OT’s must be licensed to practice in the state of Texas. Pediatrics is a specialty field of occupational therapy. Pediatric occupational therapists can specialize in sensory processing and praxis (coordinated movement).
What can occupational therapy do for pediatric patients?
Occupational therapy helps children to develop the underlying skills necessary for learning and performing specific tasks, but it also addresses social and behavioral skills. It can help with the child’s self-concept and confidence. Pediatric occupational therapy helps children develop the basic sensory awareness and motor skills needed for motor development, learning and healthy behavior. These include the following:
- body awareness (proprioceptive sense)
- coordination of movements between the two sides of the body (“crossing the midline”)
- fine motor control and organization
- motor planning
- motor movements and coordination
- gross motor coordination
- ocular motor skills
- visual perceptual skills
- sensory modulation (reaction to stimulus)
Occupational therapists not only work directly with the child, but also with the family, parents, caregivers and teachers in order to educate and reinforce specific skills and behaviors which will be used to improve and facilitate the child’s performance and functioning.
When would a family come and see you?
Any time a child is not functioning at an age appropriate level in any aspects of their life, they might see an OT for an evaluation. Children will benefit from Occupational Therapy if they have:
- Poor coordination
- Decreased balance (“clumsiness”)
- Delayed motor skill development
- Low muscle tone or strength
- Difficulty with handwriting
- Been diagnosed with a learning disability
- Difficulty completing tasks that seem easily attained by peers
- Behavioral challenges or social skill issues
- Decreased attention or ability to participate in age appropriate activities
- Decreased self-esteem and self-concept
- Decreased visual skills including visual perceptual skills and ocular motor skills
- Difficulties with feeding, is a picky eater or a messy eater
What would you tell families they should expect at their first appointment?
The first appointment is the evaluation and parent interview. Parents will be asked to fill out a caregiver questionnaire and sensorimotor history.
Many times the evaluation and the treatment itself will look and feel like play to the child. All the while, the therapist is making clinical observations of muscle tone, postural control, reflex integration, motor planning, gross and fine motor skills, sensory processing, ocular motility, and other functions related to neurological and motor development.
Various standardized tests may be administered depending on the age of the child. These include:
- Bruininks-Oseretsky Test of Motor Proficiency (BOT-2): This is a standardized test comprised of 8 subtests which provide a comprehensive index of the child’s overall motor proficiency in fine motor skills and gross motor skills. The Balance, Bilateral Coordination, Upper Limb Coordination, Manual Dexterity, Fine Motor Precision, Strength, and Agility subtests.
- The Beery Developmental Test of Visual Motor Integration Test (VMI): This test measures eye-hand coordination, motor control as well as visual information processing through a sequence of geometric forms that are copied by the child.
- Gardner Test of Visual Perceptual Skills (TVPS): This test assesses visual processing and perceptual skills eliminating the motor component.
- Peabody Developmental Motor Skills (PDMS-2): A developmental test assessing gross and fine motor skills. Subtests include: Stationary- balance reactions, trunk strength, and motor planning; Locomotion- functional mobility transitional movements, crawling, walking, running, jumping, hopping, skipping, rolling, and climbing; Object Manipulation- coordinated motor abilities that require incorporation of perception and movement, motor planning, and eye hand integration such as catching, bouncing, throwing, and kicking a ball; Grasping- manipulative movements including movements of the distal extremities that are combined with vision, proprioception, and tactile processing; Visual motor integration- Dexterity under manipulative skills including handling of blocks, copying of shapes, interpretation of visual stimuli in coordination with hand movements and perceptual skills.
- Feeding Evaluation: Consists of parent interview in addition to actual feeding assessment of the child.
Following the evaluation, the therapist writes up a report of the findings and develops a plan of care with treatment goals set to meet the individual needs of your child. A parent conference is completed with the parents and the therapist. The parent conference is a very essential part of the entire therapy process. The purpose of the parent conference is to:
- Explain the process of therapy and answer questions about how it all works
- To review the results and explain the plan of care and to educate the parents about their child’s specific profile and needs
- To discuss and identify the parent’s goals for therapy
- To provide initial home exercise/activity recommendations
What roles do the parents need to play in their child’s therapy?
The parents play a critical role in their child’s therapy. It is essential that they participate and understand what the therapist is doing and why, so they can carry over things at home. This is especially true with sensory integration. The most important way a parent or teacher can facilitate sensory processing and sensory integration is by recognizing that it exists and that it plays an important role in the development of a child. While parents and teachers provide an enriched environment that will foster healthy growth and maturation, they also want to take into account the specific needs of each individual child. Parents work together with the therapist to reach the goals to improve each child’s function and life.
Do you have recommendations for dealing with insurance?
Yes, here’s some advice for working with Medicaid and your insurance company to get the therapy your child needs.
Tell us a little bit about sensory processing disorder. What does it look like and what can be done?
Sensory Integration Dysfunction (SID)–now referred to as Sensory Processing Disorder (SPD)–is a neurological disorder. Understanding of this disorder was pioneered 40 years ago by A. Jean Ayres, PhD, OTR. Dr. Ayres developed the sensory integration theory to explain the relationship between behavior and brain functioning.
Sensory processing (sometimes called “sensory integration” or SI) is a term that refers to the way the nervous system receives messages from the senses and turns them into appropriate motor and behavioral responses. Whether you are biting into a hamburger, riding a bicycle, engaging in play activities with peers or reading a book, your successful completion of the activity requires processing sensation or “sensory integration.” Every living creature has some form of sensory integration.
Sensory Processing Disorder (SPD) is the result of neurological disorganization–when a child’s (or adult’s) nervous system has difficulty with sensory integration. SPD exists when sensory signals don’t get received or organized into appropriate responses. A child with sensory processing disorder has difficulty with processing and acting on information received through the senses, which creates challenges in function ranging from delays or difficulties with motor development, social development, and behavioral and emotional responses. SPD frequently can be present in conjunction with other neurological diagnoses.
The following are more resources about Sensory Integration.
- The American Occupational Therapy Association – Pediatric Sensory Integration Resources
- Austin Area SPD Alliance
- ComeUnity.com – a website created by a parent with articles/resources specific to SPD
- Sensory Processing Disorder Foundation
Erika Goyer is the mother of three boys and a family support navigator with Hand to Hold. Her oldest son Carrick Michael was born at 27 weeks gestation and weighed 1 pound, 14 ounces. Carrick died soon after his birth due to complications of prematurity. Erika went on to have two more high-risk pregnancies and two healthy sons, one of whom has developmental delays.