Occupational Therapy Case Study Assignment

Ashleigh Cole 100616145

Durham College (Occupational Therapy/ Physiotherapy Assistant)
OTII- 3302
Victoria Lo
Due: October 10, 2017
 1. 1) Under stimulated proprioceptive system
Jeremy is often seeking gross motor activities to provide him with more proprioceptive
feedback, such as climbing shelves and jumping off tables while in the classroom. This
creates an unsafe environment for both Jeremy and his peers. Recess time could also be
a challenge for Jeremy as he may be too rough with the other children because it gives
him more proprioceptive feedback, but the other children may not want to play with
him or think he is being mean.
2) Over stimulated auditory system
Jeremy may find regular noises that don’t bother most children to be incredibly
distracting and even painful, this can escalate when in situations with many different
loud noises. Jeremy often covers his ears when in loud situations that are overwhelming
for him. When the school has assemblies for the whole school this would be incredibly
overwhelming for him and challenging to stay focussed and calm.
Inattention is a component based impairment that Jeremy presents with that can cause
difficulties for him in the classroom (Lo, V. 2017-09-12). His inattention causes him to be
easily distracted, especially during periods of sit down quiet activities, such as circle
time. During circle time he has a hard time remaining focussed and becomes a
distraction to other students, but it also inhibits his learning as he in not able to give the
teacher his undivided attention.
2. Inattention
Jeremy has a hard time staying focussed on specific tasks, especially during sit down
quiet time. This may be due to his sensory regulation that with everything going on
within the classroom it is hard for him to keep his attention on one thing for too long.
This is displayed during circle time when he is unable to sit in the circle for a long
duration of time. This would also be challenging for Jeremy during nap time, he would
struggle to have to stay both still, and quiet without being a distraction. This would
make his learning be difficult as he would not be absorbing all the things the teacher is
teaching the class.

3.
 Personal Factors Environmental Factors Occupational Factors

 Under stimulated  Educational assistant  Attends senior

proprioceptive and  Supportive family kindergarten in a

vestibular system  School agreed to mainstream classroom

 Over stimulated auditory purchase any  Independent with

system necessary support toileting and feeding

 Inattention equipment  Emerging independence in

 Overwhelmed by large  Access to well dressing

crowds equipped sensory/  Enjoys spending time on

gross motor room computer and Ipad

 Enjoys Paw Patrol

Occupational Performance
4.  Attends SK in
 Under stimulated mainstream class
vestibular and  Independent in
proprioceptive sensory Personal toileting and
system feeding
occupational  Emerging
 Over stimulated auditory
system independence on
 Inattention dressing
 Enjoys computer,
Ipad, and Paw
 Mainstream classroom Patrol
 Access to sensory/ gross motor room
 Educational Assistant environmental
 Supportive parents
 Financial support from school for
necessary equipment
 These three circles will become more symmetrical and have more overlap the more as

Jeremys occupational performance becomes stronger and he is able to regulate his

sensory system and become independent with all his ADL’s. Occupational therapy will

help to improve his occupational performance and help him to complete his tasks more

functionally. Occupational performance is the ability to perform occupational tasks

functionally, someone with a high occupational performance would have a much more

symmetrical Venn diagram, with overlapping circles, creating a larger occupational

performance (Lo, V. OT 2017-09-26).

5. To work towards Jeremys goal of participating in circle time I would educate Jeremy and

implement the use of “first, then” statements as well as a board for picture cueing. I

would start with using this with two preferred activities, and then work towards using it

with circle time such as “first we have circle time, then we can play paw patrol on the

iPad”. This way he would have something to look forward to and be more willing to

participate in the circle time.

FIRST THEN
CIRCLE TIME PAW PATROL
I would ensure that there was always a high energy gross motor activity scheduled before circle
time, this way Jeremy can get proprioceptive and vestibular feedback and release energy so
that he will be able to have better focus during circle time. I would schedule his sensory
integration sessions before circle time so that he could have gross motor activity and let out his
energy, then he would feel calm and in focus for circle time.

Providing Jeremy with a weighted toy or vest that he would be able to use during circle time
would be a safer and less disruptive way of providing Jeremy with deep pressure and
proprioceptive feedback (National Autism Resources, 2017). This will help Jeremy to remain
seated and focussed during circle time, because he is getting continual sensory feedback during
circle time.

I would also work with Jeremy to create a 5-point scale on the expectations on how to behave
during circle time. This would work on following expectations, emotional regulations, as well as
the ability to self reflect (Total Ability, 2015). See below an example of how a 5-point scale
could be used with Jeremy. I would go through the scale with Jeremy before circle time to
remind him of the expectations during circle time, I would them see him again after circle time,
this would give him the opportunity to self reflect about his behaviour during class during circle
time and create strategies to get a better score the next time.
5 Not on carpet, moving around the class,

distracting the class with yelling and

running, invading personal space, and not

listening to teacher

4. moving around on carpet, touching

others, invading personal space,

distracting others and not listening to

teacher.

3. Sitting crossed legged, touching others

and invading personal space, distracting

other, and not listening to the teacher

2. Sitting cross legged, keeping hands to

yourself, not distracting other, not

listening to the teacher

1. Sitting crossed legged, keeping

hands to yourself and not

distracting others, and listening to

the teacher.
6. Sensory Session
Alerting Activity
When Jeremy is seeking proprioceptive and vestibular feedback he enjoys climbing the
shelves and jumping off tables in the classroom. To emulate these same movements, I
would allow Jeremy to play on the playground jungle gym as a safe outlet for gross
motor activity and sensory feedback (Lo, V. OT 2017-09-26). Jeremy would have this
gross motor activity session for three minutes before moving on to the next activity.
Organizing Activity
The OTA would create a therapeutic game revolved around the cartoon show Paw
Patrol with a goal of active deep pressure, this way he will be working towards his goals
while also having fun and being engaged in therapy (Lo, V. OT 2017-09-26). The OTA
would pile various heavy objects such as cushions, heavy exercise balls, boxes, all piled
with weighted blankets, Jeremy must help the Paw Patrol team to clear this pile which is
blocking the road into town. Jeremy will lift the object and put them in their designated
spots until the whole road is clear and he help the team save the town! Be sure to
encourage Jeremy and engage in the Paw Patrol game so he stays engaged and has fun.
This activity should last 3 minutes, and then transition on to the next activity.
Calming Activities
Jeremy will then proceed to sensory room and spend 10 minutes to relax and prepare
for the classroom setting. Jeremy will spend 4 minutes in a elastic chair with high
tension and a weighted vest where he can relax in the dim room and listen to the
calming music (National Autism Resources, 2017). The last minute will be spent doing a
belly breathing exercise with his favourite Paw Patrol toy named Marshall and watch
him move up and down to work on deep breathin (Lo, V. OT 2017-09-26). After this is
complete the OTA will take Jeremy back to the classroom and debrief with EA and
teacher about how the session went.
SOAP Note Client Name: Jeremy Tanner Date: October 1, 2017

S- Jeremy arrived at school on the school bus and stated he “hates his bus, and had to
sit in the front this morning”. Jeremy’s parents have consented to tx sessions, and
Jeremy provided verbal consent to start session. ----------------------------------------------------
O- Jeremy spent 3 minutes playing on the jungle gym on the school playground. Jeremy
enjoyed the monkey bars and swings best saying those were his “favourite things about
school”. Transitioning to the next task activity was challenging, use of a visual timer and
verbal cue of saying “one minute left” eased transitioning. Using Paw Patrol theme
helped to encourage Jeremy to engage in next activity. Prior to Jeremy arriving the OTA
prepared a pile in the gross motor room with 2 cushions, 4 exercise balls, 1 box of
papers, and 2 weighted blankets. OTA explained to Jeremy that the Paw Patrol team
needs his help to clear the rock pile so that people can get to town. Jeremy spends 3
minutes moving the object out of the way and so that the people can get through the
town. Verbal encouragement was given to keep Jeremy engaged and enthusiastic, OTA
congratulated Jeremy with high five for helping the Paw Patrol team. OTA then took
Jeremy went to the sensory room for cool down, Jeremy spent 4 minutes relaxing in
elastic chair with weighted vest, dimmed lights, and calming music playing on a low
volume. Jeremy spent last 1 minute of tx doing belly breathing in supine position with
his toy Marshall from Paw Patrol, visual cue for the toy rising and falling assisted Jeremy
in deep breathing and preparing to go back to the classroom setting. Jeremy stated he
felt “much better than when he first got to school”.-------------------------------------------------
A- Jeremy tolerate tx well, and was fully engaged throughout session. Transitioning from
outside to second task was challenging, but use of visual timer and verbal cuing on how
much time was left helped to ease transitioning, as well as use of Paw Patrol theme
which helped to keep Jeremy engaged. Visual timer was not required for second
transition, but was still there if required. Jeremy was left with EA at the classroom to
prepare for circle time.----------------------------------------------------------------

P- Discuss tx session with OT, follow up with EA and teacher regarding Jeremys success
during circle time. Continue to work towards Jeremys occupational goals. ------------------
 References

Total Ability (2015). The Incredible 5 Point Scale. Retrieved on 2017-09-27, from:

http://totalability.ca/the-incredible-5-point-scale/#

National Autism Resources (2017). Benefits of a Weighted Vest for a Child with Autism.

Retrieved on 2017-09-27, from: https://www.nationalautismresources.com/benefits-of-

a-weighted-vest-for-a-child-with-autism/

Lo, Victoria. OT (2017-09-12). OTA Therapy Skills II. [PowerPoint Slides] Retrieved from

DC Connect.

Lo, Victoria. OT (2017-09-26). Unit 3: Neurodevelopmental Conditions in Paediatrics

(Part A) [PowerPoint Slides]. Retrieved from DC Connect.