Running head: PATIENT SYNTHESIS PAPER

Salt Lake Community College

Occupational Therapy Assistant Program
OTA 1270-001
Pediatric Fieldwork I
Lisa Palmer
Spring Semester 2015
Patient Synthesis Paper

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Patient Synthesis Paper

Pediatric fieldwork in a school was a great opportunity to see how they are set up and
how occupational therapy is beneficial within an educational setting. I had the opportunity to go
to Clear Horizons Academy. They are a school in Orem, Utah for children with varying degrees
of Autism Spectrum Disorder. I was able to spend about 28 hours between four days February
18, February 25, March 4, and March 11, 2015 at this facility working with Jory Liddiard, MOT,
OTR/L, CLT, as my supervisor. This facility has 45 students with almost a 1:1 situation for each
student with teachers and Para helpers. Jory is a full time occupational therapist at Clear
Horizons Academy along with Ros Stone who is a MOT and OTR/L, that splits her time at this
school and another one of there schools in Salt Lake City, Utah. Jory and Ros split the caseload
of seeing all of the 45 students every week. Jory will see 27 of the students while Ros sees 18 of
the students. They will see each student twice during the week for 45 minutes of occupational
therapy which they do one session for about 25 minutes for sensory integration and one session
for about 20 minutes for writing. This school has based its curriculum and program off of the
Developmental, Individualized, Relationship-Based Model (DIR Model), and more specifically
aka the DIR/Floortime model. The ages of the students that come to Clear Horizons Academy
are from 3 years old to 17 years old.
I had the opportunity to go to Clear Horizons Academy four times, once each week on
Wednesday for four weeks. Each day at Clear Horizons Academy is different for the
occupational therapists. Jory gets to do handwriting, PE, cooking, and sensory room with the
kids. Each Wednesday is when he does occupational therapy with the kids he works with and he
has access to the hallways, gym, and sensory room. This gave me the chance to choose five
children and to follow them each week in the same type of setting. The activities were changed
up a bit each week and I was able to see the kids reactions in that setting.

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The one client I specifically chose to follow has severe Autism Spectrum Disorder,
Attention-Deficit/Hyperactivity Disorder (ADHD), and Obsessive Compulsive Disorder (OCD).
Each one of these disorders for the client adds on a new dimension as to what the client will or
wont do.

Some of the things he does that shows these diagnoses is he likes to have a straw at

all times with him and whenever he gets a new one it is quickly bent into the same shape as all
the others he has gotten. He does not have a very long attention span and moves from task to
task unless he receives verbal cues to remind him. He does not communicate in sentences just
mostly with one word.
Some of the functional deficits that the client has are decreased attention, fine motor
skills, maintaining attention to motor planning tasks, and sensorimotor integration. He has a
tendency to forget the steps of what he is doing and needs to have verbal prompting. It is best to
only give him two or three steps at a time. There were many times, even with only a couple of
steps, where he needed to be given verbal cues to complete the task.
The client I chose is 10 years old and lives with his dad, mom, and little brother. Mom
and dad are supportive and involved as much as they can be. Dad and mom are musicians and
dad seems to be gone quite a bit. The client has a nanny that picks him up from school everyday.
He has light brown hair, is fairly normal height for his age, and is pretty skinny.
The school is working with the client to help him independently write words using
lowercase letters with at least 85% legibility, including proper formation alignment, and spacing.
They hope he will be able to independently write lowercase letters and copy words using those
letters. They are working to help the client to maintain attention to a sensory motor activity for
over 12 minutes with only 2 verbal cues so that he can improve his attention to school tasks. To
help him with this they are trying to get him to maintain attention for ten minutes to a preferred
sensory motor task and seven minutes to a novel sensory motor task. They are also working with

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him to independently complete six of six steps to tying his shoe laces or a bow. All of these
goals will help him with attention, completing a task, and hopefully to communicate. The
parents are on board with these goals, but there are no personal goals the client has being he is
not able to communicate any with his current situation.
Some of the treatment that takes place for the client in preparation is going on a scooter
and swinging which help the client with vestibular sensory integration to get him to a point to
help him focus and maintain attention better. Some of the purposeful activities are to grab an
object, such as bean bags, and then to take and throw them into a target. This helps him with
maintaining attention to a motor planning task. Helping him to go under things to help him feel
it is safe and help with his OCD. Things that help him with occupational things are picking up
things with tweezers and using the correct amount of pressure to get them and put them into a
container. This will certainly help him with his fine motor grasp on a pencil to help in his
writing ability.
Jory worked very well with the client and he gave me the opportunity to help in some
areas. The client usually had a positive response to therapy and the activities he was doing, but
there were a few times he did not want to do what was being asked of him. The client seems to
always have a straw with him bent in the certain way he always does and when he comes for
occupational therapy time Jory takes it away from him to get him to focus on the sensory
integration things he needs to work on. There would be times during the session that the client
would go back to the area where the straw was put and point and say back to get the straw. At
this point a redirection would have to occur to get him back to the task at hand. The client would
do almost everything he was asked except going under something. Jory would try and try many
different ways and objects, such as just a rope or even a building with sides on it made from big
foam shapes, to try to get the client to not think he was going under something. It did not matter

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what Jory tried, because there is something in the clients sub-consciousness that has made him
not like or fearful of going under objects. The client showed a very intellectual side in some of
tasks like turning off a game, Bed Bugs, because he did not want any more of the bugs to come
out that he would have to pick up with tweezers. He also learned very quickly how to turn the
bugs to pick them up faster and easier. It was interesting to see this side of him knowing the
functional deficits he has.
I was not able to learn much about the clients past medical history being the school did
not have anything on file. What I was able to learn about him was from the occupational
therapists and other employees at the school. The employees understood that the client has
always had Autism Spectrum Disorder yet some of the symptoms became worse with some
abuse that occurred in his life. They said it had happened in the spring and each spring the client
becomes more agitated and less cooperative for a time. They are not sure, but think that his lack
of ability to go under things may have come from this situation also. The family seems to be
supportive, but dad and mom are not always home and the nanny helps with many things. The
parents are musicians which shows the importance of music in the clients life because in times of
distress music can be played to calm him.
Clear Horizons Academy was a great pediatric setting to have the opportunity to go for
pediatric fieldwork. The students that attend the school range in severity of Autism Spectrum
Disorder and the functional deficits they have. I would love to have the opportunity to work with
this client. He had many interesting things to learn about and to find possible options to help
him. The DIR/Floortime model the school uses is a great model of practice and works well with
the kids going there. I would certainly love to have the opportunity to work at a school like this
in the future.

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References

Solomon, J., & O'Brien, J. (2011). Pediatric skills for occupational therapy assistants (3rd ed.).
St. Louis, MO: Mosby/Elsevier.