Occupational Therapy Services
OTA The Koomar Center offers the highest quality evaluation and treatment to adolescents within the fields of Occupational Therapy and Speech and Language Therapy. This page describes the different types of evaluations that are offered at OTA as well as information on individual therapy and the variety of specialized areas that complement individual therapy that many of our therapists have expertise in.
Which evaluation you receive depends on your unique needs. Please browse the information describing our evaluations. Our intake coordinator will be happy to discuss with you which evaluation will best meet your needs. Click here to find out how to get started.
Comprehensive OT Evaluation
Most adolescents require a full comprehensive evaluation in order to begin occupational intervention services. Our comprehensive evaluation requires 12 hours of therapist time. This evaluation will give you a complete picture of the client’s sensory processing and motor needs along with recommendations for services and accommodations. It includes 2 ½ to 3 ½ hours of direct assessment, a comprehensive detailed written report, and an evaluation feedback meeting. The assessment tools used for this evaluation vary depending on the client’s age, abilities and needs, but may include the Sensory Integration and Praxis Tests (SIPT), the Pediatric Examinational Readiness of Middle Childhood (Peeramid), the OTA-Watertown Sensory Modulation and Discrimination Evaluation, the Bruininks-Oseretesky Test of Motor Proficiency, or a number of other assessment tools.
Abridged OT Evaluation
Clients whose evaluation is covered by Harvard Pilgrim Health Care (HPHC) insurance plans only are eligible for our abridged evaluation. This evaluation requires 45 minutes to 1 hour of assessment and parent feedback and includes a brief two page written report. An evaluation feedback/goal-setting meeting is strongly encouraged but not covered by this insurance plan and must be paid for separately if desired. This evaluation is not comprehensive but is sufficient to determine eligibility for occupational therapy services.
Specialty OT Evaluation
On occasions individuals may require a detailed evaluation that is focused on a specific need area such as listening, visual-vestibular integration, fine motor/handwriting skills, oral motor skills or Interactive Metronome. These specialty evaluations are tailored to meet the needs of the individual. They are most appropriate for examining, in depth, specific problems that may have been identified in another evaluation, emerged as particularly problematic during therapy services or appear to be an isolated difficulty.
Occupational Therapy Screening
In rare instances, an occupational therapy screening for a specific treatment area may be appropriate. This screening is most often used when clients are receiving other services at OTA The Koomar Center, such as speech therapy, and believe there may be other sensory-based problems or wish to determine if an adjunctive service such as cranio-sacral therapy or listening intervention may be appropriate. At times it is unclear from an initial intake if a client has sensory integration difficulties and a screening may be recommended as a first step instead of a comprehensive evaluation. A comprehensive evaluation may be recommended if indicated by the screening. A screening consists of 1 hour of assessment and a feedback checklist is provided at the end of the screening.
Occupational Therapy Intervention
Individual Occupational Therapy Intervention
Therapy is based on the unique needs of each individual working one on one with a therapist and can address difficulties with self-regulation, sensory processing, body awareness, motor planning, and development of gross motor and fine motor skills. Sessions may be conducted in small quiet rooms to work on specific target areas and may then move to larger rooms to promote social interaction, problem solving and negotiation with age appropriate peers who will also be working one on one with therapists. Therapy is engaging and motivating for an adolescent, and an adult-guided approach is used to encourage the individual to participate in purposeful activities that stimulate sensory systems that may not working as effectively as they should be. Therapy is enjoyable for the individual and is skillfully managed by the therapist to ensure it is appropriate for the adolescent. Use of the “just right challenge” ensures that the activity is not too difficult so that that he/she no longer wants to play but is not too easy so they lose interest quickly. It is this “just right challenge” that ensures the individual forms an adaptive response that will develop the functions that they find challenging.
No one can organize an individual’s brain for him/her. He has to do it himself. Though a therapy session can look casual, both therapist and client are in fact working extremely hard. All of the activities a client engages in during a therapy session are purposeful and directed toward specific goals, and the goals here are self-development and self-organization.
The development of specific therapy objectives for each individual is a very important part of the treatment planning process. Meetings can take place with the parent/caregiver and the adolescent where appropriate during the first month of therapy to establish goals and objectives that will be measured by improvement in day-to-day skills and activities.
Our occupational therapy services treat a variety of diagnoses including:
- Autistic Spectrum Disorders
- Learning disabilities
- Attention deficit disorder
- Fine and gross motor coordination disorders
- Other psychological and neurological conditions
And a variety of challenges including:
- Difficulty paying attention in class
- Difficulty organizing and executing daily activities
- Reluctance to join team sports and age appropriate activities
- Difficulty completing homework and assignments
- Poor sleep patterns
- Avoidance of parties and social situations
- Inability to attend concerts
Specialty Occupational Therapy Interventions
The use of auditory interventions as a therapeutic tool (also called sound therapy) has grown significantly in recent years. These music based programs facilitate sensory processing by impacting the auditory and vestibular sensory systems. Clinical outcomes following a sound therapy program can include improved self-regulation, attention, communication, temporal-spatial organization, motor control, visual motor skills, handwriting and reading.
Music based sound stimulation programs find their origins in the work of Dr. Alfred Tomatis, MD, a French ear, nose and throat specialist. In the 1950s Dr. Tomatis developed the first auditory training program called the Tomatis Method. Generally Tomatis’ principles and theories provide the foundation for other auditory stimulation programs.
Currently OTA-Watertown offers three different types of auditory intervention, Integrated Listening Systems (ILS) The Listening Program (TLP) and Therapeutic Listening. All programs utilize specially modified music which can be used within treatment sessions and carried over in a home program. They differ in the structure of the program implementation. For more information describing the listening interventions at OTA click here.
We offer specialized intervention to support visual-vestibular coordination. The visual and vestibular systems share an inseparable neurological and functional connection. Together, they provide the foundation for skillful and comfortable movement through space and time as well as for efficient intake of visual information for learning. The vestibular system is often referred to as the movement or balance system. The receptors are located within the inner ear, which respond to gravity and detect motion and change of head position. They tell us where we are in relationship to gravity, if we are moving or at rest, and our speed and direction of movement. The vestibular system is a powerful integrator that interacts with all other sensory systems. It most noticeably impacts our posture, balance, muscle tone, and bilateral coordination.
The visual system is more than just eyesight, or the ability to see clearly. It is also our ability to understand what we see. In school, it is estimated that at least 75% of classroom learning occurs through visual pathways. If an individual is experiencing any visual difficulties, learning will most likely be impacted.
For efficient oculomotor function, complex integration of many sensory systems must occur. According to Josephine Moore, the vestibular system is like a tripod stand that holds a camera, in that it helps hold the head stable so that the eyes can focus on an object. It contributes to bilateral integration which is important for simultaneous functioning of the two eyes together and smooth eye movements across the visual midline. Proprioceptors in the neck, eyes, and body help to coordinate movements to orient the head to the task at hand. All of these inputs together, especially the coordination between the visual and vestibular systems, are important in providing a foundation for the timing and spatial orientation of our movements and for security and comfort to navigate across environments.
- Difficulty participating in gym class, team sports and dance activities.
- Motion sickness in cars, airplanes or boats.
- Difficulty with handwriting or reading.
- Difficulty riding in elevators or on escalators
- Problems learning to drive
- Taking a long time for written or reading school work.
- Difficulty copying from the board
- Discomfort if not in front seat while riding in a car
- Fear of heights
Visual-vestibular intensives at OTA are typically for a three-week duration where the individual attends for 3 to 4 sessions a week working one-on-one with a therapist. Following the three-week intensive the therapist will discuss the recommended course of action. This may include discharge from therapy, continued therapy one time a week or a break from therapy to allow for the information to be integrated before continuing with more therapy. Click here for more information on visual vestibular integration.
Oral Motor/Feeding Therapy
Our occupational and speech therapists provide individual oral motor and feeding therapy for adolescents to increase their comfort and success with eating. In order to do so, many of the fundamental areas necessary for this success are addressed, these include improving respiration and posture, improving oral motor skills and discrimination (awareness) and decreasing oral sensitivities.
Individual therapy works to developmentally address areas that form the foundation for successful eating. Each therapeutic treatment program is based on the individual needs of the child and incorporates the goals of the client and family. Based on these needs, treatment sessions can involve different components, including sensory warm-ups (to “jump start” postural muscles necessary for eating and to assist with regulation); oral sensory activities (to increase awareness in the mouth and assist with normalizing oral tone and musculature); oral motor activities (to increase strength and control of different oral structures necessary for eating); exploration with food, (which progresses from an individual exploring food through various senses (touch, vision) and moves towards an individual eating). In addition to these specific goal areas, other areas addressed on an ongoing basis include decreasing oral sensitivities, environmental set up, “goodness of fit” of food, promotion of organization and regulation during mealtime.
Oral motor therapy utilizes direct services as well as consultation, and where appropriate, participation by caregivers. Additionally, weekly homework is provided in order to ensure carryover to natural environments. Click here for more information.
Occupational therapists and other health care practitioners use manual therapies to help the body utilize its own healing abilities to balance body functions. Several types of manual therapies are used at OTA The Koomar Center as part of an individual’s intervention program. These techniques include, but are not limited to, craniosacral therapy, myofascial release, and massage. One of the most common therapies used at OTA is craniosacral therapy. This gentle, hands-on intervention is designed to support the rhythmic flow of the cerebral spinal fluid throughout the craniosacral system (the area surrounding the brain and spinal cord). By maintaining a balance in this system, functions of the central nervous system such as reaction to sensations, emotional responses, and development of motor skills can be facilitated.
Many therapists at OTA specialize in manual therapies and routinely use these techniques as an integral part of therapy sessions. Sessions specifically devoted to manual therapy are also offered. These sessions may precede or follow the regularly scheduled sensory integration sessions, depending upon the client’s tolerance. For more information on manual therapies, click here.
The Interactive Metronome is an adjunct program to the sensory integration services provided at OTA. It is very appropriate for adolescents who have reached a plateau or end in their sensory integration services, or who have mild motor coordination difficulties. Individuals with excellent coordination skills can use the program to attain peak performance in specific sports activities.
The Interactive Metronome (IM) is a computer-based program that uses a patented auditory guidance system plus interactive exercises to improve the foundational neural mechanisms necessary for motor planning, sequencing, and rhythmicity. This involves clapping or tapping triggers in time to the metronome beat. The computer program measures the person’s response time in milliseconds and provides auditory feedback as to whether the person’s timing is too fast, too slow, or just right in response to the metronome beat.
Functional changes that are seen after completing an Interactive Metronome program are variable with each individual, but most often include improvements in timing, reciprocal social interactions, rhythm, motor coordination, sports skills, attention and impulsivity, fluidity with reading, and writing and language processing. For more information click here.