Case Study

Presentation
Marissa Stendel, OTS
OCCT 657A

Practice Setting
Pediatric Outpatient Clinic
Ayres Sensory Integration (ASI)
50 minute treatment sessions

Sensory Gym2. 2013. [Google

Image]. Retrieved from:
http://www.pillerchilddevelop
ment.com/

Sensory Gym. 2013. [Google Image].

Retrieved from: http://www.pillerchilddevelopment.com/

Retrieved from:
http://littlebinsforlit
tlehands.com/expl
oring-water-beadsscience-andsensory-play/

Client Profile: Drew

5 year old, male
Hispanic
Attended a Montessori educational approach elementary
school
No formal diagnosis
General developmental delay

Attending OT for 3 months

(Introduction to Montessori Method, 2016)

Initial Evaluation Concerns

Fine motor
Grasping and in-hand manipulation patterns

Postural control
Anti-gravity extension and flexion

Attention
Attend to task, participate in group activities with peers

Motor planning
Copy block structures, complete obstacle course with novel component,
transitioning between tasks without distress

Tactile Processing
Messy play, tolerate clothing

Bilateral Coordination
Cross midline

Initial Evaluation HEP and

Recommendations
Feeding therapy
Proprioceptive and deep pressure
Tactile activities
Self regulation
Therapeutic Listening Program

PEOP Model
Person
Neurobehavioral
Sensory and motor skills

Physiological
Good endurance, good ROM, decreased strength

Cognitive
Decreased attention

Psychological
Motivation and intrinsic factors

(Crepeau, Boyt Schell, & Cohn, 2009)

PEOP Model
Environment
Built
Sensory Integrative outpatient clinic
Home
Montessori school

Natural
Phoenix, Arizona
Dry, hot, desert climate

Cultural
Hispanic
American cultural values

Societal and Social Interaction

Parents

Social and economic system

PPO, ~ $20 co-pay
(Crepeau, Boyt Schell, & Cohn, 2009)

PEOP Model
Occupation
Abilities
Will and good attendance

Actions
Inattentiveness and sensory seeking behaviors

Tasks
Working towards goals through occupation as a means

Occupations
Self care skills, social interaction, education, play

Social and Occupational roles

Set by parents

PEOP Model
Performance

Increased
Increased
Increased
Increased
Increased
Increased
Increased

participation with therapist

independence in self care
attention
tolerance for tactile input
motor planning and sequencing
postural control
social participation

Influence of PEOP with Drew

Re-evaluation
P: Assessing Drew
E: Formal Assessments
O: ADLs, IADLs, education, leisure, social interaction

Intervention planning
Consider parents of Drew
Multiple environments

Outcomes
P: Establish, and increase skills

Ayres Sensory Integration Theory

Assumptions
To have an optimal effect on development, learning, and
behavior, the sensory input must be actively organized and
used by the child to act on and respond to the environment.
Adaptive responses are powerful forces that drive
development forward.
CNS develops hierarchically from the bottom to top.
Refinement of primitive functions such as postural control,
balance, and tactile perception, provides a sensorimotor
foundation for higher-order functions, such as academic
ability, behavioral self-regulation, and complex motor skills.
(Parham & Mailloux, 2010)

Using ASI with Drew

Nature of the setting
Address underlying sensory deficits to build higher
level executive functioning
Adaptive responses
Hyper-responsive
Tactile input

Hypo-responsive
Proprioceptive and vestibular processing

Appropriate sensory modulation

Influence of ASI with Drew

Re-evaluation
Re-eval every 6 months
SPM and PDMS-2

Address current goals

Met, Making progress, Partially met, Not met

Intervention planning
Are current goals being met?
Keeping goals and adding new goals
New concerns

What do the parents have concerns with?

Sensory, social interaction, and attention

Outcomes

Ongoing treatment
Some goals met, or making progress towards
New goals
Establish and promote

New Assessment and Plan

Assessment
Fine motor
Grasping- utilized a 4 finger grasp
In-hand manipulation patterns, Met

Postural control
Anti-gravity extension, Met
Anti-gravity flexion, Met

Attention
Attend to task, Making progress
Participate in group activities with peers, Making progress

Motor planning
Copy block structures, Met
Complete obstacle course with novel component, Partially met
Transitioning between tasks without distress, Not met

Tactile Processing
Messy play, Making Progress
Tolerate clothing, Making Progress

Bilateral Coordination
Cross midline, Met

New Assessment and Plan

Plan
Fine motor
Grasping and imitation of first name

Balance
Attention
Attend to task +15 minutes
Participate in turn taking game
Decrease sensory seeking behavior

Motor planning
Complete 4-step obstacle course with novel component
Transitioning between tasks without distress

Tactile Processing
Messy play
Tolerate seasonal clothing

Eye hand coordination

Throwing a ball using reciprocal motion
Copying simple to moderate designs from a model

References
Crepeau, E.B., Boyt Schell, B.A., & Cohn, E.S. (2009). Theory and practice in
occupational therapy. In E.B. Crepeau, E.S. Cohn, & B.A. Boyt Schell (Eds.), Willard &
Spackmans occupational therapy (11th ed., pp. 428-434). Baltimore, MD: Lippincott
Williams & Wilkins.
Introduction to Montessori Method. (2016). Retrieved February 22, 2016, from
http://amshq.org/Montessori-Education/Introduction-to-Montessori
Parham, D.L., & Mailloux, Z. (2010). Sensory Integration. In J. Case-Smith & J. C.
OBrien (Eds.), Occupational therapy for children (6th ed., pp. 325-372). Maryland
Heights, MO: Mosby Elsevier.
Sensory Gym. 2013. [Google Image]. Retrieved from:
http://www.pillerchilddevelopment.com/
Sensory Gym2. 2013. [Google Image]. Retrieved from:
http://www.pillerchilddevelopment.com/
Water beads. 2015. Retrieved from: http://littlebinsforlittlehands.com/exploring-waterbeads-science-and-sensory-play/