Perceived Efficacy and Goal Setting System - Assignment Example

173917 INTRODUCTION Occupational therapy is one of the health professions that emerged after Second World War mainly for the help of the soldierswho have gone through tremendous trauma, injury, pain and suffering and found rehabilitation almost impossible, as most of them were suffering from war syndrome. With the success of Occupational therapy in this field, slowly it was adopted into the medical system and now we know that its intervention has come to stay. Occupational therapy refers to the use of meaningful activities in the day-to-day lives of the people who cannot achieve balanced, independent life on their own. In the school settings therapists help students with mental or physical or both disabilities and assist them to maximise their skills and abilities to face the 'job of living'. It is important to know how OT can support the children with additional needs and how much support and intervention is necessary. It will also probe the need of customized treatment programmes to improve the abilities, necessity of home/job adaptation and evaluation combined with recommendations, assessment of performance skills and treatment, usage training, equipment adaptation and training to family members, carers, parents, sometimes even to teachers and monitor all the above. It is an important part of disability welfare and recurring research in this field is necessary. DEFINITION The College of Occupational Therapists define it as 'the treatment of physical and psychiatric conditions through specific activities in order to help people reach their maximum level of function and independence in all aspects of daily life'. Report (1990, p.14). "This occupational therapist is now a trained specialist who, through a study of particular aspects of certain sciences, and of practical methods of ability assessment, together with an analysis of the elements of a number of activities and of their value in rehabilitation, guides, under the prescription of the doctor, the occupational treatment of the patients referred to her," Macdonald (1977, p.2). ROLE OF OCCUPATIONAL THERAPIST IN SCHOOL SETTING Occupational therapist can provide a specialised work of prime importance at school by being a warm, receptive person who has an answer to most of the children's problems and show a real understanding of their issues. He could work with subnormal and severely subnormal children, children with brain damage, psychotic children, emotionally disturbed children and emotionally disturbed adolescents. He could imbibe development of play, manual dexterity, sensory perceptions and response to stimuli in his initial training. He can also help in developing abstract through process including concentration, observation, memorisation, using imagination, drawing conclusions and reasonable decision making, self-help and self-expression etc. He can conduct group treatment with psychotic children with facilities of a work or teaching area, a section for messy activities, a quiet room where a child could be given a much closer affection and he would need the understanding and help of school authorities. DISCUSSION Prelliwiz (2006) conducted a research on children and arrived at the conclusion that disabled children who are happy in home environment, do not perceive outside environment as friendly or accessible. Sometimes they feel marginalised, threatened; but in their own private environment, they felt secure. "In conclusion the results of this study underscore the challenges of ensuring that children with restricted mobility living in the parental home are able to have an accessible environment and to function independently in their homes. Ergonomic adaptations in the home should support these kinds of activities as the children's needs change with age and interests". This also means that the home atmosphere, to a very large extent, could be created in school too, where the disabled could have a private space and this would definitely increase the attraction of the school in their minds. Sensory integration is absolutely necessary for the OT in the case of children and has proved beyond doubt its usefulness. The first important step in this direction is identifying problematic areas the child with professional interference and the advice of other connected agencies. Therapist has base his work on professional reports and suggestions made therein. Therapist too might be able to suggest practical ways to help the child at home and at school before starting the regular therapy. Sensory integration therapy (SIT) is one of the main ways of helping the child under the circumstances. First of all, the Therapist has to seek answer to some of the following questions before planning any kind of programme for a particular child: 1. What are the main concerns of the parents and teachers 2. Whom have they already seen with these difficulties or have they recorded the problems in any way 3. Has the child already had a medical diagnosis 4. Are there any appointments coming up regarding the matter, which might show more light on the issues 5. What are the reasons behind the teachers'/parents' assuming that the child needs an assessment 6. In what way this child looks different from other children 7. What is the Child's typical day The strengths, weaknesses and the coping ability of the child could be arrived at by recording various habits of sleeping, falling asleep, waking up, eating, dressing, playing, climbing stairs, running, jumping, getting involved in a particular group play, colouring, writing, drawing, block building, recognising colours, moods and excitements, sorrows and depressions, routines, attention to lessons, behaviour with schoolmates, response to teachers, homework, doing any given task, attention wandering, school and nursery attendance, social/academic behaviour and need of special attention and support. The above will lead to the assessment of present medical status, by collecting details of diagnosis from GP/Paediatrician and other involved professionals. There is also a necessity of getting the background records of sitting, crawling, walking, weaning, toilet training, sleeping and playing. It will help to get more parenting details like the difficulties, differences noticed, handling, crying, reactions to picking up or placing down, difficulty in pacifying, excessive or insufficient wakefulness. Co-operation mapping is necessary about face/hair wash, nail cutting, clothing texture preferred, nearness to others, messy play, belligerent behaviour, loneliness preference, mouthing things, eating preferences, fiddling with objects or clothing, depth of pain reaction, reaction to dirt or unclean atmosphere, possessiveness of property. Again it is important to find out about crashing things, banging, breaking, misjudgement in showing strength, hanging on to people and furniture, poor and droopy posture, walking on toes, fidgeting, restlessness, uncomfortable reaction to any and all situations, humming, being a non-listener without being deaf, rocking unendingly, hyper-activity being never still, jumping, spinning, twirling, disliking movements, fearful of moving surfaces and bikes. It is also necessary to know how the child moves, whether the movements are fluid, jerky, or how it climbs steps, learns new skills, copies others, works out on its own, creativity, difficulty in focussing, getting bored in any activity after a short while, doing two things at once and judging space. Even the well-known professional therapists will agree that it might not work in the same way with all the children and there is a percentage of failures. Usually the changes happen quickly and it is easy to arrive at a decision about the workability of the SIT. Conventionally children are monitored all the while, but are generally seen once a week for two to four school terms. Within six weeks, some kind of change could be read in them, even though a change in the child's nervous system will take a long time to develop. Therapists say that if no changes take place within the first six weeks of the therapy, perhaps it is better to take a second look at the suitability of continuing it. "Occupational therapists can provide assessment, intervention, and consultation to help keep a child in the least restrictive classroom and living situation and to help the child achieve a better quality of life through successful participation in normal school and community activities. Greene (1993). SIT mainly targets at the improvement of the child's brain responses by creating a sensory information map to organise the movement. This needs professional planning, co-ordination techniques and co-operation from school staff as well as parents. If works well, this will increase the self-confidence and self-esteem of the child to a very large extent. SIT's dependence on enhanced sensory in-put combined with motor out-put planning. SIT's emphasis is always non-cognitive as the therapists prefer to work with the child's reactions more and this means less involvement in specific skills practice. SIT usually does not teach new skills and does not supply experience or practice to those concern-creating areas. It only involves the therapist and the child to pave way towards higher interaction with the play environment, because it is important that the child should treat any therapy session as simple playing. Thus it is necessary for the therapist to plan and design the entire strategy to develop the child's nervous system needs. Specific diagnosis could be from paediatrician, child psychiatrist and/or from child health team and usually they include autism and related conditions on the autistic spectrum of disorders, attention deficit disorders, Down's syndrome, Cerebral Palsy, learning difficulties, developmental delay, or even could be an ignored child that would react well to the therapies as soon as the lacking attention is provided. SIT is not needed in every case, but most of them require it. If the child over-reacts or under-reacts to sensory input and continues to have disorganised movement, lack of learning new tasks and poor self-confidence, non-existence of focussed attention, SI assessment could be used to identify specific areas where further help, support, therapy, guidance could be needed immediately. "For some children, it is vital that problems with balance and posture are addressed as early as possible as this can have a major impact on their coordination and ability to walk in later life. Occupational therapists often give children a series of daily activities to do at home, at school or both." http://www.direct.gov.uk/en/DisabledPeople/HealthAndSupport/WhosWhoInHealthServices/DG_4003761 Some parents are sceptical about OT at school. This does not mean that children have not been benefited by it. OT can help in achieving independence to children who are in need of it with interesting activities that children do not find dull and boring and it will improve their cognitive, motor, cognitive skills and self-esteem and they usually would not even know that they are being treated. Even though children do not have occupations other than playing and learning, OT can evaluate and improve the child's activities, performance, skills, while also developing living activity age-appropriate accomplishments. "According to the American Occupational Therapy Association (AOTA), in addition to dealing with an individual's physical well-being, occupational therapy practitioners address psychological, social, and environmental factors that may hinder an individual's functioning in different ways. This unique approach makes occupational therapy a vital part of health care for some children" http://www.kidshealth.org/parent/system/ill/occupational_therapy.html It also says that children with birth injuries/defects, sensory processing/integrative disorders, injuries to brain or spinal cord, learning problems, autism, developmental disorders, juvenile rheumatoid arthritis, mental/behavioural health problems, broken bones, other injuries, developmental delays, post-surgical conditions, burns, spina bifida, traumatic amputations, cancer, hand/leg injuries, cerebral palsy, chronic illnesses and multiple sclerosis could be widely benefited by OT, mainly because it can work on fine motor skills enabling the children to grasp, release, develop hand-eye co-ordination, better handwriting techniques, aiming, batting, hitting a target or co-ordination in drawing/sketching or copying from a book or blackboard. OT can help children in basic living tasks like bathing, dressing, eating and maintaining hygiene. It would also help in areas like anger management techniques, writing, exercising etc. OT can teach coordination skills to physically disabled children and it might result in using a computer, legible handwriting, memory power. While evaluating the child's need of wheelchair, splints, bathing seats, special chairs in classroom, playgrounds etc., it can also reduce such needs to a remarkable extent. "It may be necessary for the therapist to provide a non-directive play situation and a supportive programme. The Child's disturbances are likely to be secondary to his disease or handicap and can be helped by opportunity to use his initiative constructively, thereby increasing his self confidence," MacDonald (p. 312). Many kinds of research activities are going on in OT and many new methods are being introduced. Children with lower limb disabilities could be benefited by Tai Chi Chuan. This method is still in experimental stage; but is drawing a lot of attention. http://web.ebscohost.com/ehost/pdfvid=4&hid=102&sid=84d43657-e5d4-4efb-beba-472fbcecf21b%40sessionmgr108 Suitable craft activities could be introduced as part of OT treatment which will not only keep the children occupied, but also could be fully developed skill by the time they are old enough to work. In Norway and Scandinavian Countries, craft activities are part of OT from a very young age. Development of human relationship, interpersonal interaction, skills of conversation, and relating to another human or even an animal is also part of effective OT, already adapted by Australian therapists and UK therapists too. In Australia the necessity was felt due to the indigenous children with disabilities. CONCLUSION Recognising the changes and reviewing the progress should be imbibed into the programme by exchanging information with the teachers, and if possible, with the parents too and they could be given every opportunity to voice their concerns and worries about the changes or lack of them. Therapists work in hospitals, homes, schools, rehabilitation centres, mental health centres, children's clinics etc. OT can assess and intervene children with dysprasia/DCD by focussing on their activities at school. Their interventions include functional performance in child and school-centred care, cognitive approaches to intervention etc. OT could be using tools like Perceived Efficacy and Goal Setting system, Assessment of Motor and Process Skills, Paediatric Evaluation of Disability Inventory, Movement Assessment Battery for Children, Developmental test of visual Motor Integration, Tests of Visual Perception Skills, Motor-free Visual Perceptual test, Sensory Profile etc. A school therapist can stimulate social relationships, affective emotional balancing, intelligence, memory, ability to learn new skills, interests and concentration span, motor abilities, sensory development and a range of activities and functions that would enable the child to move forward with the educational needs. OT could help the child to study better, understand the lessons and even enjoy them. It would create a positive attitude in the child and the school could see the improvement and plan the child's studies accordingly. Principles of treatment will imbibe pre-assessment and selection, recording of progress, treatment, and monitoring. Emotional disturbance in a child might need observation of mood changes, psychosomatic symptoms, behaviour symptoms etc. It might also necessitate investigation into playing habits, play diagnosis, long term therapy, group treatment, group activities etc. Therapy can treat school phobia, severe stammer, clinging behaviour, difficulties in going into a crowd or fear of entering a large building like school/auditorium. It can also help children in coping with effects of hospitalisation, diseases of childhood, coping with family separation or bereavement, living away from home, physical restraint like a plaster cast, frame or bandages, restriction of activity like sickness, fracture, amputation. OT will be helpful while suffering from pain, discomfort, isolation, self-pity. It can suggest special measures to overcome emotional and behaviour disturbances and school authorities could act upon such suggestions. School and therapists could be partners in providing opportunities for the child's normal development. BIBLIOGRAPHY: 1. Greene, Sandra (1993), Occupational Therapy intervention with Children in School Systems, Hosp Community Psychiatry 44:429-431, May 1993. 2. Macdonald, E.M (1977), Occupational Therapy, Bialliere Tindall, London. 3. Occupational Therapy, Report of a Commission of Inquiry, Duckworth, 1990. 4. Prellwitz, Maria (2006), How Children with restricted mobility Perceive the accessibility and usability of their home environment OCCUPATIONAL THERAPY INTERNATIONAL, 13(4): 193-206 (2006. ONLINE SOURCES: 1. http://web.ebscohost.com/ehost/pdfvid=4&hid=102&sid=84d43657-e5d4-4efb-beba-472fbcecf21b%40sessionmgr108 2. http://www.kidshealth.org/parent/system/ill/occupational_therapy.html 3. http://www.direct.gov.uk/en/DisabledPeople/HealthAndSupport/WhosWhoInHealthServices/DG_4003761 Read More