Occupational Therapy Report. AREAS OF ASSESSMENT: Fine Motor Skills, Visual Motor Skills, Handwriting, Keyboarding

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1 Occupational Therapy Report Student s Name: Eric Burton EVALUATOR S NAME: Melanie Criss, OTR/L Date of Evaluation: 1/30/15 POSITION: Occupational Therapist AREAS OF ASSESSMENT: Fine Motor Skills, Visual Motor Skills, Handwriting, Keyboarding EVALUATION METHODS AND STRATEGIES: Observations Scientific, Research-Based Interventions Norm-Referenced Assessments Interviews Curriculum Based Assessments Classroom Based Assessments Review of Records and Relevant Trend Data (School records, work samples, educational history) Other: ASSESSMENT INFORMATION (Strengths, Areas of Need, Assessment Data) SUMMARY OF ASSESSMENT RESULTS: Eric was very cooperative during the occupational therapy assessment and he demonstrated an adequate attention span for the required tasks during the assessment. Several sources of information were utilized to determine the impact of Eric s fine motor, visual motor, and sensory processing skills on his ability to be successful in his educational environment. Information was obtained via the following methods: Clinical Evaluation and Informal Observation Beery-Buktenica Test of Visual-Motor Integration (psychologist report dated 3/28/14) Written Productivity Profile Sensory Processing Measure SENSORY-PROCESSING: Sensory Processing Measure (Parham & Ecker, 2007) Sensory processing is a normal brain function that takes place when sensations are received and organized in the brain so that the student can produce an appropriate response. Someone with sensory processing problems may not be able to organize sensory input and produce the best

2 response for the task at hand (e.g., they may interpret a noise or touch that is not dangerous to be dangerous and respond inappropriately). The Sensory Processing Measure (SPM) is a standardized evaluation tool for children that gather s information from teachers/caregivers about a student s sensory processing characteristics and how they affect the child s classroom behavior and performance. Parent completed the online questionnaire per request. Summary: These scores suggest areas of sensory processing that may have an impact on Eric s ability to be successful in his educational environment if not given modifications or supports. Areas listed as definite dysfunction reveal that the student s performance in this area falls significantly outside of the performance of students without sensory processing difficulties (greater than 2 standard deviations). Typical Performance Some Problems Definite Dysfunction Vision Hearing Touch Body Awareness Balance and Motion Planning and Ideas Difficulties in the area of visual sensory processing are evidenced by observations that Eric frequently seems bothered by light, especially bright light, has trouble finding an object when it is part of a group of other things, closes one eye or tips head back when looking at something or someone, becomes distressed in unusual visual environments, has difficulty controlling eye movement when following objects like a ball with the eyes, has difficulty recognizing how objects are similar or different based on their colors, shapes, or sizes, enjoys watching objects spin or move more than most kids of the same age, walks into objects or people as if they were not there, dislikes certain types of lighting, and enjoys looking at moving objects out of the corner of the eye. Difficulties in the area of hearing/auditory sensory processing are evidenced by observations that Eric frequently seems bothered by ordinary household sounds, responds negatively to loud noises, appears not to hear certain sounds, seems bothered when someone touches the face, seems frightened of sounds that do not usually cause distress in kids of the same age, seems easily distracted by background noise, and likes to cause certain sounds to happen over and over again. Difficulties in the area of touch sensory processing are evidenced by observations that Eric frequently pulls away from being touched lightly, seems to lack normal awareness of being touched, becomes distressed by the feel of new clothes, prefers to touch rather than be touched, becomes distressed by having fingernails or toenails cut, seems bothered when someone touches the face, avoids touching or playing with messy things, has an unusually high tolerance for pain, 2

3 dislikes teeth brushing more than most kids of the same age, seems to enjoy sensations that should be painful, and has trouble finding things in a bag using touch only. Difficulties in the area of body awareness are evidenced by observations that Eric frequently grasps objects so tightly that it is difficult to use the object, seems unsure of how far to raise or lower the body during movement such as sitting down or stepping over an object, seems to exert too much pressure for the task, tends to pet animals with too much force, bumps or pushes other children, chews on toys, clothes or other objects more than other children, and breaks things from pressing or pushing too hard on them. Difficulties in the area of balance and motion are evidenced by observations that Eric frequently seems excessively fearful of movement, has poor balance, avoids balance activities, falls out of a chair when shifting the body, fails to catch self when falling, seems not to get dizzy when others usually do, spins and whirls body more than other children, shows distress when head is tilted away from upright, shows poor coordination and appears to be clumsy, seems afraid of riding in elevators or escalators, and leans on other people or furniture when sitting or when trying to stand up. As described in the Sensory Processing Measure manual (Parham & Ecker, 2007), praxis is not itself a sensory system, but rather it is a higher level cognitive function that depends on the integration of multiple sensory systems, particularly tactile perception and proprioception, in order to function efficiently. Difficulties in the area of planning and ideas (i.e., praxis) are evidenced by observations that Eric frequently performs inconsistently in daily tasks, has trouble figuring out how to carry multiple objects at the same time, seems confused about how to put away materials and belongings in their correct places, fails to perform tasks in proper sequence, fails to complete tasks with multiple steps, has difficulty imitated demonstrated actions, has difficulty building to copy a model (e.g., Legos/blocks), has trouble coming up with ideas for new games and activities, and tends to play the same activities over and over rather than shifting to new activities when given the chance.. MOTOR SKILLS: Beery VMI 6 th Edition (Beery, 2010) To assess visual motor skills, the Beery-Buktenica Developmental Test of Visual Motor Integration, 5 th Edition (VMI) was administered. Average standard scores fall between VMI Standard Score: 80 Visual component Standard Score: 53 Motor Component Standard Score: 62 The VMI examines a student s visual motor integration skills by testing the student s ability to imitate and copy various geometric shapes, which are sequenced to be progressively more challenging. Eric scored in the below average range for the overall visual motor assessment 3

4 The subtests were administered to gather additional information to find out if he had any difficulties in the areas of visual perception or fine motor control. On the Visual Subtest, the assessment requires the student to match two designs from choices of similar designs that get progressively more challenging, thereby, removing the motor component. Eric scored in the significantly below average range on the visual perception subtest. On the Motor subtest, the student is required to follow a clearly defined outlined in order to make various shapes, thereby, removing the visual component. Eric scored significantly below average on the motor subtest indicating he will have difficulty with academic tasks that require fine motor precision such as remaining within a small defined space and writing neatly. Written Productivity Profile Gathering data on handwriting and keyboarding is useful when making decisions about a student s written productivity. To gather data, students complete similar tasks using handwriting and keyboarding. It is important to determine which form of written communication would enhance a student s ability to compose his/her ideas to the greatest potential. A Written Productivity Profile (Keyboarding/ Handwriting comparison) can assist in making an informed decision as to whether or not using technology as an alternative writing medium will be beneficial for a student who may struggle with the task of handwriting. General observation of Eric s handwriting revealed that he used a left-handed three-finger tripod grasp to hold the pencil. During the assessment, Eric rested his pencil hand appropriately on the paper and he did stabilize the paper with his non-dominant hand. Eric used an excessive amount of force on the pencil during writing and reported that his hand hurt during some portions of the assessment that involved paper pencil tasks (e.g., after number 25 on the motor subtest of VMI). Parent reports Eric experiences hand tremors and a mild hand tremor did appear to be present during some of the testing. Eric exhibited some challenges with the handwriting process as evidenced by the following percentage scores for the handwriting assessment (which did not involve the cognitive task of developing content or generating ideas): Memory 77% due to capital substitutions (Target 100% for his age) Orientation (absence of reversals) 100% (Target 100%) Letter placement on the line 80% (Target 95%) Spacing - 70% accuracy (Target 100%) Fine motor letter control (e.g., looking for open gaps, curves that should be pointed, points that should be straight or curved, extra lines, unnecessary line extensions) 46% (Target 95%) Eric s handwriting speeds were compared to his keyboarding speeds and it was noted that he has the ability to handwrite sentences at 9 words per minute and type sentences from a model at a speed of 30 words per minute. When examining his keyboarding more closely, it was noted that Eric used a two-handed index only finger typing approach during typing tasks. 4

5 For students in 6 th grade and older, speeds for handwriting, based on published norms, should be at least 9-18 words per minute to be functional for success in the classroom and Eric did demonstrate the ability to produce written work at these speeds during the copying portion of the assessment; however, when asked to write a sentence of his own his speed decreased to 3 words per minute. When using typing as a method for written expression, the ability to type at speeds at least equal to or faster than handwriting would be important and Eric is already typing much faster than he is writing. Typing is a much more efficient alternative for Eric to produce written assignments. With typing tasks, he consistently failed to use punctuation and capitalization correctly. In light of significant challenges with motor control that impact handwriting, Eric may be a good candidate for speech recognition. Clinical Observations Eric demonstrates good in-hand manipulation skills as he demonstrated success with shifting small objects from his palm to his fingers and his fingers to his palm, even when presented with multiple objects in his hand at one time. Eric also demonstrated the ability to use simple rotation (e.g., flipping a penny over) and complex rotation as required to rotate objects between his fingers (e.g., a pencil from the tip to the eraser end). Eric was also able to isolate his fingers to imitate finger movements made by the evaluator (e.g., numbers, I love you sign). ACTIVITIES OF DAILY LIVING: The Roll Evaluation of Activities of Life (REAL) is a standardized rating scale that includes the activities of daily living (ADLs) and independent activities of daily living (IADLs) most common among children ages 2 years to 18 years of age. Activities of Daily Living include basic life skills such as dressing, hygiene/grooming, feeding, toileting, and functional mobility; whereas, Instrumental Activities of Daily Living are more complex skills that are needed to navigate successfully in the community such as financial management, community mobility, health management, shopping, meal preparation and clean-up, and communication management. On the REAL, parents or caregivers rate their child s demonstration of various skills and the evaluation results in an ADL score and an IADL score. Eric s father completed the rating scale based on his observed performance at home. Eric s ADL score was 108/222 giving him a standard score of <67.1 which is in the significantly below average range. ADL areas that were rated included dressing, hygiene/grooming, feeding, toileting, and functional mobility. Eric s IADL score was 16/173 giving him a standard score of <76.1 which is in the significantly below average range. IADL areas that were rated included housework/chores, managing money/shopping, meal preparation, personal safety, traveling, and school-related skills (planning/organization/communication). Average standard scores on this assessment are Below is a list of specific tasks from the REAL assessment that Eric was reported to have consistent difficulty with at this time (reported either unable or seldom completes) that will be important skills to develop for independence in the community: 5

6 Dressing (fasteners, putting on shoes) Hygiene (brushing teeth, brushing hair, washing hands well) Feeding (eating from all food groups, using spoon and fork well, pouring liquid from a pitcher) Toileting (completing toileting sequence and hygiene tasks such as flushing, washing hands, using necessary supplies) Housework/Chores (picking up belongings, following written list of chores, loading dishwasher/washing dishes) Managing Money and Shopping (cannot count money or tell time or identify value of coins) Meal Preparation (planning and preparing a meal or snack) Personal Safety (simple first aid, stranger awareness) Travelling (using key to unlock door, follow directions to nearby location) School-Related Skills (bringing necessary materials or supplies to complete school work, assignments, or projects, completing homework on time, using an organization system to keep track of assignments, tests, and projects) Description of Educational Needs: Overall, Eric exhibited the greatest difficulty in the areas of visual motor skills and fine motor control, in addition to independent living skills (activities of daily living and instrumental activities of daily living). Eric needs to have access to technology for greatest efficiency with writing tasks and needs to improve his keyboarding skills for greater success in the virtual environment. Eric also needs to be working toward increased independence with self-care and daily living. Implications for Instruction and Progress Monitoring: Based upon the assessment, Eric would benefit from occupational therapy services to address challenges with activities of daily living, visual motor skills, and fine motor skills. Occupational therapy can facilitate the use of technology to improve his written communication. The use of technology is often a highly effective option to alleviate the mechanical aspects of writing that affects performance. Occupational therapy services may be appropriate to work with Eric on increasing independence in written expression through the use of technology. It may also be beneficial to work on some strategies that may be helpful for functional, short writing tasks such as filling out a form or a simple worksheet. Some recommendations include the following: Extended time for tasks that require handwritten work Assignments that require handwriting should be limited to short assignments allowing for the use of technology for assignments that would require more lengthy writing 6

7 Use of a word processor to bypass the complex motor demands associated with handwriting Exploration of speech recognition software to assist Eric with written expression secondary to significant difficulty with speed and spelling If notes can be provided, or perhaps an outline with spaces left for him to type in the information, for Eric as opposed to requiring him to take notes, this may increase his success with studying for exams Consider use of a recording device to take notes or to play back his ideas for practicing his touch typing as part of his class assignments Additional typing instruction may be of benefit to Eric to increase his typing speed and accuracy with finger placement. There are several free typing resources/games/instructions online including and to name a couple. Multi-sensory keyboarding methods (ideas will be provided by the occupational therapist) could be beneficial as well. The use of a handwriting checklist as a reference during required handwritten assignments and for proof reading/corrections. This can be used in conjunction with a review of the strategies outlined in the One Hour to Legibility program by the Handwriting Clinic/First Strokes Handwriting (which will be provided by the occupational therapist). Evaluator: Melanie Criss, OTD, OTR/L (Occupational Therapist) 7