Working Together: How Collaborate · Raising a sensory smart child: The definitive handbook for helping your child with sensory integration issues. New York, NY: Penguin Books. Bly,

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Working Together: How

OTs, PTs, and SLPs Can

Collaborate

Kenzie Davis, MS CCC-SLP

Jane Weedon, MS PT

Alyssa Fagan, OTD, OTR/L

Please no video or audio

recordings during the

presentation to protect the

confidentiality of the children

in our case studies.

● Participants will understand how OT, PT, and ST can

collaborate to achieve therapeutic goals and learning

objectives.

● Participants will learn developmental milestones for

PT, OT, and ST. Participants will also identify

characteristics of language processing and sensory

processing disorders.

● Participants will identify when to refer children for ST

and OT evaluations along with special instruction

services, play therapy, and neuropsychological

evaluations.

Learning Objectives

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● Participants will understand how PT interventions

can help with global delays and improve ST and OT

goals along with school learning objectives.

● Participants will learn how to integrate some

language processing, speech production, and

sensory integration/regulation techniques to help

facilitate PT goals and outcomes.

● Participants will learn “red flags” when children are

not meeting developmental milestones for PT, OT,

and ST.

Learning Objectives (cont.)

● Key Aspects of ST, OT & PT

● Collaboration Definition & Trends

● Interdisciplinary Overlap

● Case Studies

● Implications for PT Intervention

● Red Flags

● Questions or Comments?

Outline for Today

Speech-language pathologists (SLPs) work to

prevent, assess, diagnose, and treat speech,

language, social communication, cognitive-

communication, and swallowing disorders in

children and adults.(American Speech-Language Hearing Association, 2018)

Role of a Speech-Language

Pathologist

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● Joint Attention

● Receptive Language

● Expressive Language

● Pragmatic Language

● Speech Production (Articulation, Phonology)

● Oral Motor Skills

● Feeding & Swallowing

● Fluency (Stuttering)

● Voice

Speech Therapy Goal Areas

Occupational therapists (OTs) use daily

activities or “occupations” to promote health,

wellness, and the improvement or

enhancement of participation in roles, habits

and routines for individuals and groups in

various contexts. (American Occupational Therapy Association, 2014)

Role of an Occupational

Therapist

● Upper Body/Core Strength and Endurance

● Bilateral Coordination

● Eye-Hand Coordination

● Sensory Processing

● Fine Motor Skills

● Visual Perception

● Visual Motor Integration

● Self-care or Activities of Daily Living (ADL’s)

Occupational Therapy Goal Areas

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Sensory Modulation

Sensory Overresponsivity, Sensory

Underresponsivity,

Sensory Craving

Sensory-Based Motor Disorders

Dyspraxia, Postural Disorders

Sensory Discrimination Disorder

Visual, Auditory, Tactile, Vestibular,

Proprioception, Taste/Smell,

Interoception

(Miller, Anzalone, Lane, Cermak & Osten, 2007)

Proposed Nosology of Sensory Processing Disorder

● Strength

● Endurance (Muscular and Cardiovascular)

● Motor Coordination

● Balance

● Body/Safety Awareness

● Gross Motor Skills

● Tone, Reflexes

● Motor Learning

● Joint Range of Motion, Posture

Physical Therapy Goal Areas

CPSE- Committee on Preschool Special Education

- Funded by NYC Department of Education

- Provides evaluations and therapy for children ages 3-5

CSE- Committee on Special Education

- Funded by NYC Department of Education

- Provides evaluations and therapy for school-aged

children over age 5

EI- Early Intervention

- Funded by the NYS Department of Health

- Provides evaluations and therapy for children 0-3

DOE- New York City Department of Education

General Acronyms

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“Collaborative practice happens when

multiple health workers from different

professional backgrounds work together with

patients, families, carers and communities to

deliver the highest quality of care.”

World Health Organization, 2010, p. 7

Increased area of importance based on complex

needs in early intervention and school-based

settings

More recent research and professional

accrediting bodies in support of formal

Interprofessional Education (IPE)

Del Rossi et al. 2017; Kerfeld, Pitonyak, and Jirikowic, 2017; Teeters Myers and Peganoff

O’Brien, 2015

Interprofessional Collaboration

● Understanding professional roles

● Communication

● Trust & Teamwork

● Problem-solving

● Belief in & advocacy for collaboration

(Del Rossi, Kientz, Padden, McGinnis, and Pawlowska, 2017; Peabody & Demanchick, 2016)

Interprofessional Collaboration

Requirements

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● Increased demands in kindergarten

classrooms since late 1990s:

○ Teacher expectations

○ Curricular content

○ Fewer activity/play centers

○ Use of standardized testing (Bassok, Latham, & Rorem, 2016)

● Therapies sought for skill enrichment (Harris, 2015)

Trends

● Child Factors: Shifts in diagnoses,

increased premature survival rates,

increased rare genetic dx, global

processing delays, increased anxiety, ADD,

ADHD, ASD

● Contextual influences: Later

diagnosis, starting school earlier, over-

scheduled, influence of technology,

caregiver stressors, urban stressors

Anecdotal Trends

● Task Breakdown: “Stand up, Put on Your

Shoes & Line Up”

● Venn Diagram

● Video Case Studies

Interdisciplinary Overlap

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1. Stand up from yoga mat

1. Locate shoes in classroom & navigate

getting to shoes

1. Sitting and putting on shoes amidst

peers

1. Standing up and forming a line with

peers

“Stand up, Put on Your Shoes & Line Up”

Task Analysis/Discipline Overlap

(Task: “Stand up, put your shoes on and line up”)

ST

OT

PT

- Distinguish

directions amidst

classroom stimuli.

- Visually locate shoes.

- Have spatial awareness so

can sit down amidst peers.

- Pair shoe with correct

foot.- Tying the laces with

adequate dexterity.

- Awareness

to stand in

personal

space.

- Comprehend and follow 3-

step commands.

- Know where shoes are kept.

- Know where to line up.

- Vocabulary associated with

shoe fastening. - Remember and recall

sequence in correct order.

- Maintain focus without

getting distracted.- Understand spatial

concepts such as “in

front”, “next to”,

“behind” and motor

plan body movements

accordingly.

- Navigate classroom

without bumping into

peers and furniture.

- Use bilateral hand

skills to fasten shoe.

- Fasten shoe with

adequate tightness.

- Exhibit co-contraction and mid-

range muscle control to stabilize

core; push with lower leg; pull with

bilateral hands.

- Sit down in controlled

manner.

Zeke Shoes Video

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What did you see?

● 3-year, 6-month old male

● Receives ST, OT and SEIT

● Dx sensory processing disorder

● Emerging expressive language and play skills

● Reduced attention to language and tasks

● Reduced ability to follow directives

● Impulsivity

● Difficulty peer interactions

● Decreased body awareness

Case Study #1: Zeke

ST: Zeke will follow familiar 3-step verbal

command given visual cues and minimal

clinician repetition of the instructions in a

variety of settings in 4 of 5 attempts.

OT: With minimal verbal prompting, Zeke

will don his shoes with competing visual

sensory stimuli present (i.e. another peer)

in 3 consecutive sessions.

Sample Therapeutic Goals

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● Overall strengthening activities

especially torso

● Endurance activities

● Oppositional alternating movement

activities

● Crossing midline and trunk rotation

activities

● Motor planning activities

● Movement sequencing activities

● Balance activities

PT Intervention

● Plan with speech

therapist specific

words/phrases to

use

● Repetition of

established language

each session

● Use picture board

for sequencing,

motor planning

PT Intervention

ST

OT● Minimize visual

distractions in PT gym

● Minimize number of

other people in PT gym

● Minimize external sound

in PT gym

● Visual stimuli slowly

added to build up

tolerance

● Proprioceptive input

● Tactile tapping of: shoe,

foot, hand to bring gaze

to task

● Move chair to face wall

Review Zeke Shoes Video

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Shoes

Talking

Dexter Videos

What did you see?

Case Study #2: Dexter

● 4-year, 2-month old male

● Receives ST and PT

● Strong expressive language and play skills

● Overall low tone

● Reduced speech intelligibility

● Lateralization of fricative sounds

● Nasality

● Reduced attention to listener

● Decreased gradation of movement

● Decreased proprioception

● Decreased body and safety awareness

● Decreased balance and stability

● Decreased protective reactions

● Decreased endurance

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ST: Given verbal prompts, Dexter will

exhibit a closed mouth posture for up to 5

minutes when engaging in a structured play

task in the therapy room in 4 of 5

attempts.

OT: Dexter will demonstrate spontaneous

midline crossing during self-care and

structured play tasks in 4 of 5 attempts.

Sample ST & OT Therapeutic Goals

● Cues to close mouth,

tongue inside mouth:

verbal/tactile

● Torso strengthening

for good alignment

of head, jaw, tongue

● Endurance for breath

control

PT Intervention

ST

OT

● Cues and toys that

require bilateral hand

coordination

● Activities that require

reaching across midline

● Torso strengthening

along with trunk

rotation activities

● Raising the surface level

● Providing visual cue on

floor for maintaining

position

● Manual facilitation

Shoes

Talking

Dexter Videos

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● Providing modeling of directives

● Using simplified language

● Breaking down each step of a multi-step

command

● Providing visual supports

Language Processing

Considerations for PT Intervention

● Forward head posture

● Low torso strength/posture

● Midrange motor control of muscles

that support breath/jaw control

● Difficulty with sustained phonation

● Reduced ability to dissociate tongue

movement from jaw

Speech Production Considerations

for PT Intervention

Sensory Modulation

Sensory Overresponsivity, Sensory

Underresponsivity,

Sensory Craving

Sensory-Based Motor Disorders

Dyspraxia, Postural Disorders

Sensory Discrimination Disorder

Visual, Auditory, Tactile, Vestibular,

Proprioception, Taste/Smell,

(Miller, Anzalone, Lane, Cermak & Osten, 2007)

Proposed Nosology of Sensory Processing Disorder

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○ What is it?

○ Think THRESHOLDS

○ Environmental considerations

Sensory Processing Considerations for

PT Intervention

Calming Techniques:

Rhythmic breathing,

rhythmic rocking, heavy

work, reduced

auditory/visual stimuli

Alerting Techniques:

Oscillatory or arrhythmic

movement, heavy work,

increased auditory/visual

stimuli

Sensory

Modulation

Sensory Processing Considerations

for PT Intervention

● Readiness for PT

● Understand child’s sensory triggers

● Modify environment to help with sensory

triggers

● Provide proprioceptive input

Visual Tracking & Perceptual

Considerations for PT Intervention

● Visual tracking/scanning and gross

motor skills

● Postural control

● Midline crossing

● Depth perception

● Figure ground

● Timing

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● Frequent tripping and falling

● Frequent leaning

● Excessive muscle tone (low or high)

● Bumping or crashing into objects or

people

● Avoidance of certain activities

● Favors one-side of body

● Fatigues quickly/sits down during gross

motor activities

PT Red FlagsWhen to Make a Referral

PT Red Flags (cont.)When to Make a Referral

● Awkward movements

● Ball handling decreased (throwing,

kicking, catching)

● Difficulty on the playground

● Difficulty riding a tricycle or bicycle

● Holding or fixing postures

● Can’t keep up with peers

● Doesn’t obtain new motor skills

● Consistently avoidant of a physical skill

ST Red FlagsWhen to Make a Referral

Infant/Early Toddler

● Reduced eye contact

● Not pointing

● Reduced joint attention

● No babbling

● Can’t follow one-step commands by 1-year

● No words by 1-year

● Less than 50 words by 2-years

● Reduced ability to use words for more than just

labeling

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ST Red Flags (cont.)When to Make a Referral

Preschool

● Difficulty following multi-step commands

● Difficulty using multi-word sentences to respond to

wh-questions

● Reduced ability to comment spontaneously

● Difficulty engaging in conversation

● Difficulty logically recalling events/telling a story

● Difficulty playing interactively with peers

● Decreased speech intelligibility

OT Red Flags When to Make a Referral

Difficulty engaging in age-appropriate occupations

● Achieving pre-academic skills: engaging with

different materials in various contexts, varying

demands

● Gaining independence with self-care skills:

eating, dressing, toileting

● Engaging in play: interacting with manipulatives

and play equipment, peer interactions, self-

regulation

● Manipulating clothing,

shoes

● Managing utensils, cups

● Puzzles and shape

sorters

● Grasp on crayons, paint

brushes

● Drops things frequently

● Visually tracking objects

OT Red Flags (cont.)Difficulty with:

● Drawing shapes, writing

name

● Attention to task

● Textures (eating,

playing, dressing)

● Movement (playground,

stairs)

● Frequent tantrums

● Social interactions

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Other Red Flags

Play Therapy

● Trauma

● Mental disorders

● Learning and

social issues

● Play scenarios &

themes

● Distinguishing

between play and

reality

● Regression in play

Special Instruction

● Developmental

delay

● Physical

● Cognitive

● Communication

● Social-Emotional

● Self-help

Neuropsychology

● Learning

● Attention &

Memory

● Language

Processing

● Visuospatial

● Executive

Functions

● Emotional

Functions

Dexter: One year later...

Questions or

Comments?

4/12/2018

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Contact Information

Kenzie Davis: [email protected]

Jane Weedon: [email protected]

Alyssa Fagan: [email protected]

Biel, L., & Peske, N. (2005). Raising a sensory smart child: The definitive

handbook for helping your child with sensory integration issues. New

York, NY: Penguin Books.

Bly, L. (1983). The components of normal movement during the first year

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Cheatum, B. A., & Hammond, A. A. (1999). Physical activities for

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Hanft, B., & Shepherd, J. (2016). Collaborating for student success: A

guide for school-based occupational therapy (2nd ed.). Bethesda,

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Resources

Henry, D., Kane-Wineland, M., & Swindeman, S. (2007). Tools for tots:

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OT Services.

Linder, T. (1990). Transdisciplinary play-based assessment: A functional

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Weiss, D., Tilin, F., & Morgan, M. (2014). The interprofessional healthcare

team. Burlington, MA: Jones and Bartlett Learning.

Resources (cont.)

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American Occupational Therapy Association. (2014). Occupational therapy practice

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

68(Suppl. 1), S1-S48.

Bassok, D., Latham, S., & Rorem, A. (2016). Is kindergarten the new first grade? AERA Open,

1(4), 1-31.

Del Rossi, L., Kientz, M., Padden, M. McGinnis, P., & Pawlowska, M. (2017). A novel

approach to pediatric education using interprofessional collaboration. Journal of

Physical Therapy Education, 31(2), 119-129.

Kerfeld, C. I., Pitonyak, J. S., & Jirikowic, T. (2017). Enhancing student interprofessional

teamwork and collaboration through pediatric therapy learning experiences. Journal of

Physical Therapy Education, 31(3), 114-120.

Miller, L.J., Anzalone, M.E., Lane, S.J., Cermak, S.A., & Osten, E.T. (2007). Concept

evolution in sensory integration: A proposed nosology for diagnosis. American Journal

of Occupational Therapy, 61, 135-140.

Peabody, M.A., & Demanchick, S.P. (2016). Interprofessional opportunities: Understanding

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178-185.

World Health Organization. (2010). Framework for Action on Interprofessional Education

and Collaborative Practice. Geneva: WHO Press. Retrieved from

http://apps.who.int/iris/bitstream/handle/10665/70185/WHO_HRH_HPN_10.3_eng.pd

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