Transcription:
What is Occupational Therapy/Services Provided at Pediatric Rehab

Bill Klaproth (Host): As a parent, you want to see your child grow and learn and thrive and children with developmental disabilities or injuries need specialized care to help them achieve their goals. And here to talk about occupational therapy and the services provided at Pediatric Rehab is Brianna McGovern an occupational therapist at Pediatric Occupational Therapy at Southern New Hampshire Health. Brianna, welcome to the podcast.

Brianna McGovern (Guest): Hi, thank you for having me.

Host: You bet. So, Brianna, tell us about the services offered at the Pediatric Rehab office at Southern New Hampshire Health.

Brianna: Sure. So, we are an outpatient rehab office so, we offer physical therapy, speech and language therapy, and occupational therapy. So, I can certainly speak the most to occupational therapy and kind of what we offer. So, we offer individualized occupational therapy treatment, typically focusing on sensory processing needs but certainly a wider variety. And then we also have a couple of specialized programs that we do aquatic therapy once a week, and then one of our OTs is also involved in our feeding team evaluations. So, that includes an OT, an SLT and a nutritionist.

So, we really kind of have a good variety here in our staff. We are pretty lucky. We have kind of a wide variety of expertise. So, some of us have advanced sensory integration training. We have others with advanced reflex integration training. One of our OTs comes from a long history in the schools, so we really do kind of have a pretty well-rounded group which we are pretty fortunate to have.

Host: That sounds good. And what ages do you normally see?

Brianna: So, I would say probably our biggest age range is kind of like that three to seven to eight-year-olds, but we certainly have seen birth to three ages, and we’ll see kind of kids into their late teens, potentially even early 20s depending on the functional need. We kind of go through it with the patient and determine is this the best fit versus an adult-based clinic in terms of what we offer and the services we have and things like that.

Host: And who typically gets referred for occupational therapy?

Brianna: It can be a pretty wide range. I’d say our biggest population is kids on the autism spectrum. We have quite a few that we see with Down’s Syndrome, kind of general developmental delays, ADD, ADHD. But we also see quite a few without any formal diagnosis but just functionally they are somewhat struggling somehow.

Host: So, what is the role then, of a pediatric occupational therapist?

Brianna: So, I find that a lot of times that if people haven’t had experience with OT it can be kind of a vague kind of unknown. So, for us, for pediatrics a general sense I suppose focus on developing, restoring, adapting functional independence in some way. So, for kids, their kind of daily occupations tend to be self-care skills so that could be getting dressed, following a multistep sequence and feeding and eating. Another huge area of occupation for kids is play. So, developing age-appropriate play skills, shifting attention, turn taking, managing frustration throughout their day tends to be a big area. And then kind of the motor foundations behind all of that independence.

So, bilateral coordination and motor planning, fine motor skills to manipulate small objects, utensils, things like that within their day is kind of our scope. So, it’s very broad and is certainly individualize depending on the need of the patient.

Host: You were talking about motor skills. Is that what sensory processing is? What does sensory processing mean because we hear that term?

Brianna: Yeah so that is definitely kind of an overarching big area we tend to focus on and kind of assess in treatment. In a general sense, it’s kind of just our body’s way of taking in the sensory stimuli to create an output. So, in laymen’s terms, essentially, we recognize a sensory stimuli, so say it’s wintertime and we hear a loud crash coming from the other room or something. Our bodies interpret that and decide there seems to be a problem. I need to get up and address that or I’ve heard that before, that’s snow falling off the roof. I can kind of negate that and move on with my day. I know that’s unimportant.

So, for these kids that we are seeing, oftentimes the sensory processing, this kind of balance of sensory intake and outtake isn’t quite processing as efficiently. So, they might be under responding to certain stimuli or over responding to certain stimuli. So, they could be over responding to tactile input which is kind of our sense of touch. So, that can manifest as sensitivities to clothing types or food textures. If they are under responding to what we call proprioception which is kind of our input to our muscles and joints; they may appear to be clumsy or not have a strong sense of where they are in space, so often bumping into things.

So, we kind of work to get those sensory systems working together more efficiently so they can kind of be more functional throughout their day.

Host: So, what is the process then for being seen for occupational therapy?

Brianna: So, typically we require a doctor’s order before an evaluation occurs, but we certainly have parents that call on their own and say heh, you know, this is a concern. My child is struggling, can I get them in for an eval. And we can certainly always reach out to the doctor and say these are the concerns. Is it appropriate to get an order? Otherwise, sometimes the doctors directly will refer. We’ve had teachers refer before. So, really either the parent or the doctor can call and just say I’m concerned regarding X, Y, and Z, I’d like to get an initial evaluation started.

Host: And how often then, are children usually seen for therapy?

Brianna: So, recommendations are generally determined at the time of the evaluation in terms of frequency and duration. I would say typically; treatment sessions are an hour in length. Our most common frequency is usually once a week, but sometimes once every other week if it’s kind of a more subtle or mild case. So, it’s kind of determined by the therapist at the time of the eval and kind of discussed with the family at that point.

Host: And do you ever have the same child come back for therapy at another time, once they’ve been discharged?

Brianna: We do, yes. So, our treatment plan in general, is really focused on this notion of episodic care so meaning, you don’t just come in for OT and are kind of seen for life. So, what are the presenting concerns? That’s what we are going to focus on for our current treatment plan. And when they’re met, they are discharged. But given the fact that we work in pediatrics and kids are growing and changing so quickly; expectations and functional demands certainly change too. So, while they may be discharged at one point because they were doing well; give it a year or two and now expectations have increased and they are kind of struggling again, we certainly see kids again. And we kind of reiterate that with families as well. That just because they’re discharged, wonderful, they are doing great; that doesn’t mean that they wont need OT again and that’s okay too.

Host: So, Brianna, let me ask you this. For children that are receiving occupational therapy services through the public school, are they still able to be seen by you as well?

Brianna: Yeah, absolutely. And that’s a question that we do get a lot. Because I think there can be some confusion there. But school-based and outpatient OT is definitely different. The focus on school is just that. OT within the school system focuses on children’s success within the educational system versus outpatient where we can really focus more on success at home, within the community. So, our focus can be a little bit broader in outpatient so therefore it’s not typically considered a dual service because we are working on things outside of the school-based setting.

Host: And what about occupational therapy through early intervention? Is there a difference then in treatment or services?

Brianna: Yeah and I actually, I came from early intervention before coming here. So, I’ve kind of had experience in both. So, EI if some don’t know is a state run funded program for specifically the birth to three population. So, EI is performed in-home so the therapists or the developmental specialists come to their home and again, it’s state funded. So, it’s a little bit different. In that case, if we here in outpatient are seeing that birth to three age as well; typically families would have to decide which one they want to go to EI versus outpatient because in that case; the focus of treatment tends to overlap which then would be considered a dual service.

So, we kind of leave it up to the families at that point but yeah, typically, our focus is the same. It’s just our treatment model itself that’s different. We obviously have families come to us in office. It’s not state funded of course, so it’s billed through insurance somewhat differently. So, those are kind of the biggest differences I suppose and then it’s certainly up to family preference and what’s going to be easiest for them.

Host: So, Brianna, what else should we know about the OT at the Pediatric Rehab Center that we haven’t already discussed?

Brianna: We kind of went through the basics in terms of what we offer, what we do, but kind of in a more general sense. Out thought is always if you are ever on the fence whether you are a provider or a family; if you are ever on the fence as to whether or not and OT referral might even be appropriate, we are so much more apt to just say give us a call. Our front desk is wonderful. They can always put us back and we can speak to the family or provider directly and kind of problem solve together. Because we have kind of had a mixed bag in terms of if that situation happens yeah, I think that’s appropriate come on in for an eval and sometimes it hasn’t been.

But at the same time, we have been able to then problem solve and decide what might be a better fit whether that’s psych counseling or sometimes we kind of decide that they may be more appropriate for an adult-based clinic. So, we are happy to problem solve. We’re here. We like to think we are pretty accessible in terms of being able to speak directly to families if there is ever any questions. So, that would be kind of my biggest take away.

Host: So, it sounds like the overall message is you’re there to help, if you have questions, reach out and you’ll be there for someone.

Brianna: Absolutely. Absolutely.

Host: Brianna, thank you so much for your time today. For more information on occupational therapy, please visit www.snhhealth.org. Once again, www.snhhealth.org and be sure to subscribe to Simply Healthy in Apple podcasts, Google Play or wherever you listen to your podcasts and check back soon for our next episode. This is Simply Healthy a podcast by Southern New Hampshire Health. I’m Bill Klaproth. Thanks for listening.