Occupational Therapy Services
OTA The Koomar Center offers the highest quality evaluation and treatment to adults within the fields of Occupational Therapy and Speech and Language Therapy.
Many adults have sensory processing disorders that make daily activities challenging or even impossible. For example, auditory sensitivities may interfere with the ability to work, ride public transportation, and participate in family activities. Tactile defensiveness often creates difficulties with intimacy with a spouse or significant other and frequently affects interpersonal relationships with friends, co-workers, and family. Vestibular processing problems can affect the ability to drive, ride in airplanes, and engage in daily activities such as descending stairs, riding a bike, walking on uneven surfaces (e.g., when hiking), and navigating terrain such as icy sidewalks (Kinnealey, Oliver, & Wilbarger, 1995). Adults with sensory processing problems, especially those with sensory defensiveness, often present to others as being controlling, picky, and overly sensitive (Oliver, 1990). They often report high levels of anxiety and depression, commonly have a history of post-traumatic stress disorder (PTSD) or trauma (Kinnealey & Fuiek, 1999), and may have tried years of counseling and medication before arriving at occupational therapy.
The Evaluation Process
Here at OTA we tailor the initial consult, evaluation and treatment approach to meet the individual’s needs. Initial consults can take place over the phone or in an in-person conversation at the clinic. Most clients benefit from a comprehensive evaluation. The therapist will decide with the individual the best approach for this, but it usually takes the form of a consultation or interview as well as some time spent in the clinic to explore how the individual responds to different types of sensory input. During this process the therapist will obtain a comprehensive clinical history to determine the type and nature of the client’s sensory integration and motor problems and how those difficulties are affecting participation and occupations,as well as the client’s social-emotional state.
Clients covered by Harvard Pilgrim Health Care (HPHC) insurance plans only are eligible for our abridged evaluation. This evaluation requires 45 minutes to one hour of assessment and 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 out-of-pocket if desired. This evaluation is not comprehensive but is sufficient to determine eligibility for occupational therapy services.
Specialty Occupational Therapy Interventions
The use of auditory interventions as a therapeutic tool (also called sound therapy) has grown significantly in the past 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 and visual motor skills.
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 The Koomar Center offers three different types of auditory intervention: Integrated Listening Systems (ILS), The Listening Program (TLP), and Therapeutic Listening. Both programs utilize specially modified CDs 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.
Visual Vestibular Intervention
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 and 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. 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.
Adults that have problems with visual-vestibular coordination may exhibit:
- Difficulty driving (reading road signs, merging on the highway)
- A dislike of flying in airplanes
- Difficulty “getting it together” throughout each day
- Motion sickness in cars, airplanes or boats
- Needing to spend a lot of time and energy getting organized
- Discomfort if not in front seat while riding in a car
- Fear of heights
- Loss of balance when a bus or subway stops quickly
- Difficulty navigating through grocery store, department store or mall
- Difficulty with maps and directions
Click here for more information on visual-vestibular integration.
Occupational therapists, physical 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, 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 and are typically 30-45 minutes in length. These sessions may precede or follow the regularly scheduled sensory integration sessions, depending upon the client’s tolerance. Click here for more information.
The Interactive Metronome (IM) is an adjunct program to the sensory integration services provided at OTA. It is most appropriate for individuals who have reached a plateau or end in their sensory integration services, or who have mild motor coordination difficulties. Other 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 rythmicity. 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.