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Case Study Presentation

O CCT 657A
Presented by:
Evelyn Babaroudi, OTS
Touro University, Nevada

Placem ent Setting


Site: Los Angeles Unified School District (LAUSD)
Setting: School-Based

School-Based O ccupationalTherapy
Postural stability
Self-help skills
Fine motor skills
Sensory processing
Social and play abilities
Visual motor and perception
Task completion and organization
School-Based Occupational Therapy. (2016). Retrieved from:

https://www.google.com/search?q=schoolbased+OT&biw=1366&bih=644&source=lnms&tbm=isch&sa=X
&ved=0ahUKEwjakejOs5TLAhXLVh4KHRXhBl4Q_AUIBigB#imgrc=
sCL8L9XTd6XveM%3A

Client D escription
Name: Jacob Flores
Age: 9 years, 11 months
Gender: Male
Eligibility: Multiple Disabilities-Orthopedic
Medical Diagnosis: Traumatic Brain Injury; Cerebral Palsy
Curriculum: Alternate Curriculum
Placement: Special Education
Friendly and cooperative

M edicalH istory
Full-term, uncomplicated pregnancy
Accident at 9 months of age
Seizure
Intentional head trauma
Department of Children and Family Services
Mr. Flores arrested
Diagnosis
Hydrocephalus
Cortical bleeding in left eye
Severe brain damage

Background
Resides with maternal grandparents
Primarily Spanish speaking household
Parents visit on weekends

O ccupationalTherapy Services
Frequency: 1-5
Interval: Monthly
Minutes: 60
Service Delivery Model: Direct Service (Collaborative)

Person-Environm ent-O ccupationPerform ance (PEO P)


Model
Person-Environment-Occupation-Performance
Theorists
Christiansen & Baum
Focus
Holistic and client-centered approach
Change
Person, environment, and occupation intrinsically
intertwined
Guidelines
Collaboration with client and family

(Christiansen & Baum,


2005)

PEO P M odel

(Christiansen & Baum,

Person
Person
Physiological
Decreased upper-extremity tone and strength
Cognitive
Attention and problem-solving skills
Expressive and receptive language
Spiritual
Kindness
Enthusiasm
Neurobehavioral
Right side preference
Views objects at close range
Psychological
Self-esteem and self-efficacy

Environm ent
Built
Assistive technology
Natural
Classroom
Playground
Cultural
Student success

Societal
Social acceptance from peers
Social interaction
Family, school staff, and skilled services
Social and economic system
California Childrens Services

O ccupation
Abilities
Motor skills
Process skills
Actions
Fine motor tasks
Visual motor tasks
Tasks
Functional writing
Occupations
Educational participation
Social and occupational roles
Student

Perform ance
Seating, positioning, and performance of physical activities
Decreased upper-extremity strength and tone
Response to sensations in environment
Difficulty determining qualities of smaller objects
Unable to manipulate objects using refined movements of hands
Visual skills for academic performance
Able to use visual skills functionally
Manipulation and management of classroom materials
Demonstrates functional ability to rake
Requires extra time to grasp and release objects
Sensory and motor skills for written communication
Maximal prompting to determine boundaries of pictures or image
Unable to stay on designated lines when tracing

Perform ance, Cont.


Impact of disability
Demonstrates needs with fine motor and visual motor skills
Motor and visual impairments limiting access to curriculum
Cortical visual impairment
Decreased upper-extremity strength and tone

O ccupationalAdaptation (O A)
Occupation
Adaptation
Increase adaptability in order to increase function

(Schultz, 2014)

Assum ptions of O A M odel


Six guiding assumptions
1. Competence in occupation
2.
3.
4.
5.
6.

Demands to perform
Dysfunction
Adaptive capacity
Demand for changes
Success in occupational performance

(Schultz, 2014)

Person
Desire
for
Master
y

Interaction
Performance
Process
for
Mastery

Occupational
Deman
d for
Mastery

Occupational Challenge

Person

Occupational Role
Expectations

Occupational Response

Occupatio
nal
Performan
ce

Applying O A to Client
1) Person
Physical
Visual
Access and participation in school activities
2) Occupational Environment
Curriculum
Level of performance in learning
3) Interaction
Fine motor and visual motor skills
Limiting access to curriculum
Reasons for adaptive response:
Interaction with environment creates occupational challenges
In order to function more efficiently, adaptation must occur

PEO P & O A: Evaluation


Identify activity demands and factors supporting or
hindering access to curriculum
Complete thorough history and systems review,
considering domains that influence function
Develop summary of childs strengths and needs
Teacher interview
Parent interview
School observations
Clinical observations
Record review

PEO P & O A: Intervention Planning and


Im plem entation
Planning:
Help Jacob master his environment and increase occupational performance
in fine motor and visual motor skills

Implementation:
Adaptations and modifications
Assistive technology
Tactile learning strategies
Collaborating with teacher
Advancing Childrens Educational Success

Monitor and document process


Observation
Record review

Large keys & large key keyboards. (2016). Retrieved from:


https://www.google.com/search?
q=touch+screen+computer+large+keys+keyboard&biw=1366&bih=
673&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjfmICjpJTLAhWBK
x4KHf02DswQ_AUIBigB#imgrc=kqQFdRwoyjxAxM%3A

PEO P & O A: Intervention Planning and


Im plem entation, Cont.
OT Goal:
Using assistive technology (Pixwriter, etc.), Jacob will compose
simple subject/predicate sentences with 80% accuracy in 4/5
trials.

Treatment ideas:
Utilize a dark (black surface) before placing items on table
Attempt letter formation through dot art-activities
Collaborate with teacher on access to AT

Sensory Letters. (2016). Retrieved from: https://www.google.com/search?


q=puffy+paint+letter+formation&biw=1366&bih=673&source=lnms&tbm=isc
h&sa=X&ved=0ahUKEwj05rqDqZTLAhVE3GMKHdSHAioQ_AUIBigB#imgrc=YslS
q-82SKCW9M%3A

PEO P & O A: O utcom es


Participation
Access and participation in meaningful school activities
Ability to express written communication

Role competence
Ability to meet the demands of the student role

ACES. (2016). Retrieved from:


http://achieve.lausd.net/cms/lib08/CA01000043/Centric
ity/domain/168/brochures/ADVANCING%20CHILDRENS
%20EDUCATION%20SUCCESS%20ENGLISH.pdf

(AOTA, 2014)

References
American Occupational Therapy Association. (2014). Occupational therapy practice
framework: Domain

and process (3rd ed.). American Journal of Occupational Therapy,

68(Suppl. 1), S1-S48. http://dx.doi.org/10.5041/ajot.2014.682006


Baum, C.M, & Christiansen, C.H. (2005). Person-environment-occupation-performance:
An occupation-

based framework for practice. In C.H. Christiansen, C.M. Baum, and J.

Bass-Haugen (Eds.),

Occupational therapy: Performance, participation, and well-being

(3rd ed.). Thorofare, NJ: SLACK Incorporated.


Schultz, S.W. (2014). Theory of occupational adaptation. In B. A. B. Schell, G. Gillen, &
M. E. Scaffa (Eds.), Willard & Spackmans occupational therapy (12th ed., pp. 529533). Philadelphia: Lippincott

Williams & Wilkins.

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