Considers client motivation when using occupation based intervention to maximize functional independence
Without motivating factors, we are not inclined to do something that needs to be done. The same is true for children. If a child is not provided with internal or external motivation, then he or she will not want to attempt or complete a task because there is no incentive for him or her to do so. At my second fieldwork site, there was a 13-year old boy with Down syndrome who had been noted to change motivations weekly on his in-class motivation chart. The in-class motivation chart was a collaboration between the child and his teacher to know what he was working toward that day. According to the site's occupational therapist, she had constantly sought out what motivated the child to ensure progress in therapy since they changed so frequently. In fact, it got to the point where his motivators, such as the Alabama football songs and chants, time with his best friend and schoolmate, and videos of the Power Rangers, were no longer motivating.
My fieldwork educator and I discussed at length possible motivators for our client. She shared that he really liked swinging on the platform swing but he wanted to do it the entire OT session. (This is a problem because a typical OT session in this setting is usually 30 minutes and 15 of those are normally spent transitioning the child from the classroom to the gym and vice versa. Transitioning can be difficult for this population because unexpected changes disrupt the child's routine and can lead to a meltdown. When a meltdown occurs, it takes skilled services to help the child overcome those emotions and to develop self-regulation and coping skills, usually through a form of sensory input, i.e. vestibular, tactile, visual, proprioceptive, auditory.) As the days went by, I also learned that his teacher wanted him to increase his pencil pressure on the paper when writing because she was having a hard time seeing his words on paper. At this point I started to make note of his sensory-seeking behaviors that were impacting his ability to participate in classroom and therapy activities. (1) Vestibular Input: He likes the feeling of the platform swing because it moves him in a horizontal linear direction or in a circumferential direction if he is spun. (2) Tactile & Proprioceptive Input: Due to his low muscle tone, he is having a hard time pressing down with his pencil onto the paper to write legibly and may feel he is pressing down already. He also may have trouble where his hand and arm are in space while performing writing activities. I concluded he was showing signs of above-normal thresholds for vestibular and tactile sensory input, based on what I had made note of with his teacher's comments and discussions with the school's OT. Additionally, I feel that my pediatrics class provided a solid foundation for sensory thresholds to identify when a child is either seeking or avoiding a specific kind of sensory input. I believe this helped me identify that the child desired sensory input above any other tangible motivating factor. When I discussed it with my fieldwork educator, we both agreed that it was worth determining whether his sensory-seeking behavior was a strong enough motivator to get him to come to therapy and eventually do work in the classroom.
Finally, his therapy day arrived and my fieldwork educator let me lead the session. In class we learned that humans like being offered choices, especially between two less-preferred activities, because it provides a sense of control -- children are no exception. The child is given a sense of control in his decision of the first activity he will do. It may not be what he would pick if given other options, but with the current selection, he will choose the one he wants to start with. When a child feels like he is a part of the decision-making process for his therapy session, it helps the therapeutic relationship and also keeps the client motivated because he made the decision himself -- not the therapy student. I immediately offer him two choices. One, we either start therapy with a handwriting activity, or two, we start with the platform swing but only for 5 minutes. I add to the latter that he can get more time on the swing if he completes his work after the initial 5 minutes. He asks for the swing. I started with him on the platform swing, moving in a linear fashion with an occasional spin to help him reach his sensory threshold (i.e. vestibular and proprioception) to quench his sensory-seeking behaviors long enough for us to do tabletop work. In occupational therapy, you normally swing the child in a linear fashion to not only help the child reach threshold but to also help him calm down. You spin the child in a circular motion to raise his energy levels and also help the child reach his sensory threshold. At this point, I've noted that he's motivated by sensory input, but I needed confirmation that he would be more willing to participate in a less-preferred activity like handwriting after reaching threshold. After the 5 minutes were up, he transitioned to the table with minimal resistance. We worked on two of his goals, which he quickly worked through -- normally he writes at a very slow pace -- and I rewarded him with 5 more minutes on the platform swing. Again, after the 5 minutes were up, he transitioned back to the table with no resistance. I started him with a handwriting task to see how his handwriting was. It was very light which made it hard to make out. Thinking quickly, I found a wrist weight, had him pause, and placed it on his dominant wrist. I observed the client to pick his arm up and look at the wrist weight from every angle with a disgusted expression. Based on his expression, I would guess he wasn't too keen to the idea of having something on his wrist. I asked him to write and I saw a noticeable improvement. He wrote darker, making it easier to read his writing. The purpose of the wrist weight was to provide additional tactile and proprioceptive input. Many times when children with low tone, which is common in individuals with Down syndrome, write, their letters are lighter and poorly shaped because they have difficulty controlling the pencil. Poor control of the pencil is due to poor awareness of where his hand is in space, where the pencil needs to move on the paper, and how much force needs to be applied when using the pencil to write on the paper. The wrist weight provides that tactile input to first allow the client to identify where his hand is in space. When he moves his hand and arm to write, his proprioceptive feedback loop kicks in to let him know whether he has placed the pencil in relation to his paper and he is able to correct his positioning if necessary. The wrist weight also serves as an aid to help the child press his pencil down harder into the paper to make more legible marks. At the end of the activity I asked if he liked the wrist weight. His face lit up. I relayed this information to his teacher so she would be on board with him wearing it in class during writing activities.
After a week, his teacher told me that every time she announced it was "time to write" my client would reach into his desk and put on his wrist weight. She noted that he was much more motivated to participate in activities because he was getting through his work better than before. I explained to her that we had been incorporating more sensory input, specifically vestibular, into our therapy sessions to motivate him to participate in therapy and classroom activities.
My fieldwork educator and I discussed at length possible motivators for our client. She shared that he really liked swinging on the platform swing but he wanted to do it the entire OT session. (This is a problem because a typical OT session in this setting is usually 30 minutes and 15 of those are normally spent transitioning the child from the classroom to the gym and vice versa. Transitioning can be difficult for this population because unexpected changes disrupt the child's routine and can lead to a meltdown. When a meltdown occurs, it takes skilled services to help the child overcome those emotions and to develop self-regulation and coping skills, usually through a form of sensory input, i.e. vestibular, tactile, visual, proprioceptive, auditory.) As the days went by, I also learned that his teacher wanted him to increase his pencil pressure on the paper when writing because she was having a hard time seeing his words on paper. At this point I started to make note of his sensory-seeking behaviors that were impacting his ability to participate in classroom and therapy activities. (1) Vestibular Input: He likes the feeling of the platform swing because it moves him in a horizontal linear direction or in a circumferential direction if he is spun. (2) Tactile & Proprioceptive Input: Due to his low muscle tone, he is having a hard time pressing down with his pencil onto the paper to write legibly and may feel he is pressing down already. He also may have trouble where his hand and arm are in space while performing writing activities. I concluded he was showing signs of above-normal thresholds for vestibular and tactile sensory input, based on what I had made note of with his teacher's comments and discussions with the school's OT. Additionally, I feel that my pediatrics class provided a solid foundation for sensory thresholds to identify when a child is either seeking or avoiding a specific kind of sensory input. I believe this helped me identify that the child desired sensory input above any other tangible motivating factor. When I discussed it with my fieldwork educator, we both agreed that it was worth determining whether his sensory-seeking behavior was a strong enough motivator to get him to come to therapy and eventually do work in the classroom.
Finally, his therapy day arrived and my fieldwork educator let me lead the session. In class we learned that humans like being offered choices, especially between two less-preferred activities, because it provides a sense of control -- children are no exception. The child is given a sense of control in his decision of the first activity he will do. It may not be what he would pick if given other options, but with the current selection, he will choose the one he wants to start with. When a child feels like he is a part of the decision-making process for his therapy session, it helps the therapeutic relationship and also keeps the client motivated because he made the decision himself -- not the therapy student. I immediately offer him two choices. One, we either start therapy with a handwriting activity, or two, we start with the platform swing but only for 5 minutes. I add to the latter that he can get more time on the swing if he completes his work after the initial 5 minutes. He asks for the swing. I started with him on the platform swing, moving in a linear fashion with an occasional spin to help him reach his sensory threshold (i.e. vestibular and proprioception) to quench his sensory-seeking behaviors long enough for us to do tabletop work. In occupational therapy, you normally swing the child in a linear fashion to not only help the child reach threshold but to also help him calm down. You spin the child in a circular motion to raise his energy levels and also help the child reach his sensory threshold. At this point, I've noted that he's motivated by sensory input, but I needed confirmation that he would be more willing to participate in a less-preferred activity like handwriting after reaching threshold. After the 5 minutes were up, he transitioned to the table with minimal resistance. We worked on two of his goals, which he quickly worked through -- normally he writes at a very slow pace -- and I rewarded him with 5 more minutes on the platform swing. Again, after the 5 minutes were up, he transitioned back to the table with no resistance. I started him with a handwriting task to see how his handwriting was. It was very light which made it hard to make out. Thinking quickly, I found a wrist weight, had him pause, and placed it on his dominant wrist. I observed the client to pick his arm up and look at the wrist weight from every angle with a disgusted expression. Based on his expression, I would guess he wasn't too keen to the idea of having something on his wrist. I asked him to write and I saw a noticeable improvement. He wrote darker, making it easier to read his writing. The purpose of the wrist weight was to provide additional tactile and proprioceptive input. Many times when children with low tone, which is common in individuals with Down syndrome, write, their letters are lighter and poorly shaped because they have difficulty controlling the pencil. Poor control of the pencil is due to poor awareness of where his hand is in space, where the pencil needs to move on the paper, and how much force needs to be applied when using the pencil to write on the paper. The wrist weight provides that tactile input to first allow the client to identify where his hand is in space. When he moves his hand and arm to write, his proprioceptive feedback loop kicks in to let him know whether he has placed the pencil in relation to his paper and he is able to correct his positioning if necessary. The wrist weight also serves as an aid to help the child press his pencil down harder into the paper to make more legible marks. At the end of the activity I asked if he liked the wrist weight. His face lit up. I relayed this information to his teacher so she would be on board with him wearing it in class during writing activities.
After a week, his teacher told me that every time she announced it was "time to write" my client would reach into his desk and put on his wrist weight. She noted that he was much more motivated to participate in activities because he was getting through his work better than before. I explained to her that we had been incorporating more sensory input, specifically vestibular, into our therapy sessions to motivate him to participate in therapy and classroom activities.
In this picture, the 13-year old boy participated in various Halloween activities but the "Wrap the Mummy" activity was one of his favorites. As you can see, I am wrapped in toilet paper. My client was able to wrap me with the toilet paper after receiving a visual demonstration. He thought it was so funny and wanted a picture of it.